@Article{info:doi/10.2196/50892,
author="Al Anazi, Samaa
and Bajamal, Eman
and Hantira, Neama
and Esheaba, Ola",
title="Exploring Parental Experiences With School-Aged Children Receiving Web-Based Learning: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="19",
volume="6",
pages="e50892",
keywords="education",
keywords="obstacles",
keywords="online learning",
keywords="stress reduction",
keywords="obstacle",
keywords="parent",
keywords="parents",
keywords="parental",
keywords="parenting",
keywords="e-learning",
keywords="child",
keywords="children",
keywords="school",
keywords="schools",
keywords="student",
keywords="students",
keywords="experiences",
keywords="experience",
keywords="interaction",
keywords="health outcome",
keywords="health outcomes",
keywords="family",
keywords="dynamic",
keywords="dynamics",
keywords="parental experiences",
abstract="Background: Web-based learning has transformed education. Its ability to overcome physical barriers and deliver knowledge at the click of a button has made web-based learning popular and ensured that it will continue to be used in the future. The involvement of parents in web-based learning is fundamental to the success of the educational process, but limited attention has been paid to the impact of web-based learning on parents. Objective: This study examined parental experiences with school-aged children receiving web-based learning in Jeddah, Saudi Arabia. Methods: We sent cross-sectional, anonymous web-based questionnaires to school-aged children's parents. A total of 184 parents completed the survey. Results: Parents' negative experiences of web-based learning (mean 4.13, SD 0.62) exceeded their positive experiences (mean 3.52, SD 0.65). The most negative experience reported by parents was their child's boredom due to prolonged sitting in front of a device (mean 4.56, SD 0.69). The most positive experience was their child's technological skill enhancement (mean 3.98, SD 88). Their child's lack of social interaction and friendship building promoted stress among parents (r=?0.190; P=.01). At the same time, their child's technological skill enhancement reduced stress among parents (r=0.261; P=.001). The most reported (63/184, 34.2\%) obstacle to web-based learning was having multiple learners in the same household. Conclusion: Web-based learning is a fundamental learning method and will continue to be used in the future because of its ability to overcome many barriers to education. Parental involvement in the continuity and success of the web-based learning process is crucial. However, the findings of this study illustrated that parents' experiences of web-based learning were more negative than positive. Parents who reported negative experiences reported an increase in stress and faced more obstacles due to web-based learning. Thus, more attention and intervention are needed to promote positive web-based learning experiences among parents. ",
doi="10.2196/50892",
url="https://pediatrics.jmir.org/2023/1/e50892"
}


@Article{info:doi/10.2196/40043,
author="El Sherif, Reem
and Pluye, Pierre
and Paquet, Virginie
and Ibekwe, Fidelia
and Grad, Roland",
title="How People Use Web-Based Parenting Information to Support Others in Their Social Circle: Qualitative Descriptive Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Apr",
day="28",
volume="6",
pages="e40043",
keywords="consumer health information",
keywords="information seeking behavior",
keywords="child development",
keywords="child health",
keywords="information outcomes",
keywords="health information",
keywords="digital health",
keywords="parenting",
keywords="web-based information",
abstract="Background: Almost two-thirds of the North American population have searched for health information on the web, and the majority report searching on behalf of someone else in their social circle, a phenomenon referred to as proxy seeking. Little is known about how proxy seekers use web-based health information and the outcomes they experience. Objective: The main aim of this study was to explore why proxy seekers used a parenting website on behalf of parents in their social circle and the outcomes they reported. Methods: A qualitative descriptive study was conducted in the context of a partnership with a web-based parenting resource to explore the contexts and motivations for proxy web-based health information seeking, use of information, and subsequent outcomes. A total of 14 participants who self-identified as family members, friends of parents of young children, or professionals who worked with young children were interviewed, and a thematic analysis was conducted. Results: The following 4 reasons for proxy seeking were uncovered: for reassurance, out of personal curiosity, as part of a professional role, or following an explicit request from the parents. Information was used to provide informational support for parents or material support for a child. Positive outcomes of using the information and some of the resulting interpersonal tensions were described. Conclusions: This study provides an in-depth look at proxy seeking behavior and outcomes among users of a web-based parenting resource. ",
doi="10.2196/40043",
url="https://pediatrics.jmir.org/2023/1/e40043",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115603"
}


@Article{info:doi/10.2196/43673,
author="Perkes, Jane Sarah
and Huntriss, Belinda
and Skinner, Noelene
and Leece, Bernise
and Dobson, Rosie
and Mattes, Joerg
and Hall, Kerry
and Bonevski, Billie",
title="Evaluation of an mHealth Intervention (Growin' Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="26",
volume="6",
pages="e43673",
keywords="mobile health",
keywords="mHealth",
keywords="co-design",
keywords="Aboriginal and Torres Strait Islander",
keywords="mother",
keywords="baby",
keywords="young children",
keywords="mobile phone",
abstract="Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women's and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin' Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin' Up Healthy Jarjums---a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages---for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87\%, mothers and n=6, 13\%, health professionals). Interviews were completed by 78\% (32/41) of the women and 100\% (6/6) health professionals. Of the 41 mothers, 31 (76\%) women accessed the application, 13 (42\%) scrolled the main page only, and 18 (58\%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94\%) reported that Growin' Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19\%) mothers reported technical problems with accessing the application. Moreover, 44\% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin' Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin' Up Healthy Jarjums program at improving health outcomes. ",
doi="10.2196/43673",
url="https://pediatrics.jmir.org/2023/1/e43673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37234043"
}


@Article{info:doi/10.2196/43626,
author="Li, Kexin
and Magnuson, I. Katherine
and Beuley, Grace
and Davis, Logan
and Ryan-Pettes, R. Stacy",
title="Features, Design, and Adherence to Evidence-Based Behavioral Parenting Principles in Commercial mHealth Parenting Apps: Systematic Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Jun",
day="1",
volume="6",
pages="e43626",
keywords="mobile phone",
keywords="parent",
keywords="behavioral parent training",
keywords="parent management training",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="child",
keywords="adolescent",
abstract="Background: There is a need to disseminate evidence-based parenting interventions for adolescent externalizing concerns. Although family-based treatments have demonstrated efficacy for such concerns, they have limitations and challenges when disseminated in the community. Behavioral-based parenting techniques form an integral part of well-established, family-based interventions for adolescent behavioral problems and are ideal for dissemination through coupling with smartphone technology. Despite the vast number of ``parent'' apps currently available in commercial markets, there is a dearth of reviews focused on evaluating mobile health apps through the lens of behavioral parenting training (BPT). Objective: This study aimed to conduct a systematic review of commercial mobile health apps for parents to increase effective parenting skills that include behavioral components. Methods: A search of the Google Play and Apple App Stores identified 57 apps that were included in the review and coded for availability, popularity, and infrastructure. In total, 89\% (51/57) of them were sufficiently functional to be assessed for app design quality (engagement, functionality, esthetics, and information), and 53\% (30/57) proceeded to the final evaluation of level of adherence to BPT principles. Results: In total, 57 apps met the initial inclusion criteria. Accessibility was high across these apps given that 44\% (25/57) were available on both the Google Play and Apple App Stores and 68\% (39/57) were free of charge. However, privacy concerns were addressed inconsistently among the apps. App design quality was average across the included apps, and apps with positive user star ratings or a high number of downloads received higher ratings on app design quality. In contrast, the identified apps largely fell short in providing BPT components adequately and with high interactivity, with low levels of adherence to BPT (mean 20.74\%, SD 11\%) across all commercial apps evaluated. Commercially popular apps did not show higher levels of adherence to BPT. Overall, a moderate relationship between app design quality and adherence to BPT was found. App features that have been found to increase user engagement, such as gamification and individualization, were only observed in a small minority of apps. Overall, there was a lack of focus on teenage development. Conclusions: Future app developers hoping to increase the dissemination of BPT should aim for free and accessible apps that balance high-quality design features (eg, simple esthetics, interactivity, and individualization) with content consistent with BPT principles. They should also consider key issues that are inconsistently addressed in current apps, including privacy and teenage development. Future app developments will likely benefit from multisector (industry and academic) collaboration throughout the design process and involving end users (ie, parents) during different stages of app development. ",
doi="10.2196/43626",
url="https://pediatrics.jmir.org/2023/1/e43626",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261886"
}


@Article{info:doi/10.2196/41779,
author="Weber, Joy Summer
and Mulvaney, A. Shelagh
and Faiola, Anthony
and Brown, Madeline
and Koyama, Tatsuki
and Sun, Lili
and Goggans, Lynn Susanna
and Hull, Carmen Pamela",
title="Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation",
journal="JMIR Pediatr Parent",
year="2023",
month="Oct",
day="13",
volume="6",
pages="e41779",
keywords="goal setting",
keywords="goal tracking",
keywords="nutrition",
keywords="health behavior",
keywords="parents",
keywords="children",
keywords="mobile apps",
abstract="Background: Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. Objective: This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps' general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). Methods: Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. Results: Of the 21 apps identified, 16 (76\%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38\%), physical activity and screen time (5/16, 31\%), sleep (7/16, 44\%), and personal hygiene (6/16, 38\%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ?4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. Conclusions: Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals. ",
doi="10.2196/41779",
url="https://pediatrics.jmir.org/2023/1/e41779",
url="http://www.ncbi.nlm.nih.gov/pubmed/37831486"
}


@Article{info:doi/10.2196/48934,
author="Facca, Danica
and Hall, Jodi
and Hiebert, Bradley
and Donelle, Lorie",
title="Understanding the Tensions of ``Good Motherhood'' Through Women's Digital Technology Use: Descriptive Qualitative Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Oct",
day="25",
volume="6",
pages="e48934",
keywords="motherhood",
keywords="parenting",
keywords="digital health",
keywords="apps",
keywords="social media",
keywords="mother",
keywords="parent",
keywords="technology use",
keywords="use",
keywords="computer use",
keywords="interview",
keywords="interviews",
keywords="perspective",
keywords="perspectives",
keywords="mothers",
keywords="mobile phone",
abstract="Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of ``good motherhood.'' Given the ways in which digital technologies can both support and hinder women's perceptions of their parenting abilities, understanding expectant and new mothers' experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers' use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants' experiences of using digital technologies in the transition to parenting period were captured within the overarching theme ``balancing the tensions of digital technology use in the transition to parenting'' and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered ``in-the-moment'' access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. ",
doi="10.2196/48934",
url="https://pediatrics.jmir.org/2023/1/e48934",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878372"
}


@Article{info:doi/10.2196/48004,
author="McMann, Tiana
and Wenzel, Christine
and Le, Nicolette
and Li, Zhuoran
and Xu, Qing
and Cuomo, E. Raphael
and Mackey, Tim",
title="Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="30",
volume="6",
pages="e48004",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="pediatric vaccine",
keywords="pediatric COVID-19 vaccine",
keywords="vaccine beliefs",
keywords="vaccine-related concerns",
keywords="vaccine-related confidence",
keywords="vaccine barriers",
keywords="vaccine facilitators",
keywords="racial and ethnic minority",
abstract="Background: Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19--related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective: This study aimed to characterize COVID-19 vaccine--related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods: We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine--related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results: A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01\%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71\% vs 2090/3106, 67.29\%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7\%). Conclusions: Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations. ",
doi="10.2196/48004",
url="https://pediatrics.jmir.org/2023/1/e48004"
}


@Article{info:doi/10.2196/44792,
author="Yau, W. Kiana
and Tang, S. Tricia
and G{\"o}rges, Matthias
and Pinkney, Susan
and Amed, Shazhan",
title="Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="17",
volume="6",
pages="e44792",
keywords="childhood obesity",
keywords="mobile health",
keywords="health behaviors",
keywords="prevention",
keywords="mobile health app",
keywords="mHealth app",
keywords="human-centered design",
keywords="cocreation",
keywords="participatory approach",
keywords="mobile phone",
abstract="Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ?5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ?1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children's Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36\% male; 5/14, 36\% White), 12 parents (9/12, 75\% aged 40-49 years; 2/12, 17\% male; 7/12, 58\% White), and 18 HCPs participated; most parents and children (20/26, 77\%) participated in ?2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users' behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76\%) and found 79\% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users' interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. ",
doi="10.2196/44792",
url="https://pediatrics.jmir.org/2023/1/e44792",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195754"
}


@Article{info:doi/10.2196/41806,
author="Darien, Kaja
and Lee, Susan
and Knowles, Kayla
and Wood, Sarah
and Langer, D. Miriam
and Lazar, Nellie
and Dowshen, Nadia",
title="Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="18",
volume="6",
pages="e41806",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="prophylaxis",
keywords="internet use",
keywords="search engine",
keywords="adolescent",
keywords="youth",
keywords="pediatric",
keywords="adolescence",
keywords="young adult",
keywords="readability",
keywords="human immunodeficiency virus",
keywords="HIV",
keywords="virtual assistant",
keywords="health information",
keywords="information quality",
keywords="accuracy",
keywords="credibility",
keywords="patient education",
keywords="comprehension",
keywords="comprehensible",
keywords="web-based",
keywords="online information",
keywords="sexual health",
keywords="reading level",
abstract="Background: Adolescents and young adults are disproportionately affected by HIV, suggesting that HIV prevention methods such as pre-exposure prophylaxis (PrEP) should focus on this group as a priority. As digital natives, youth likely turn to internet resources regarding health topics they may not feel comfortable discussing with their medical providers. To optimize informed decision-making by adolescents and young adults most impacted by HIV, the information from internet searches should be educational, accurate, and readable. Objective: The aims of this study were to compare the accuracy of web-based PrEP information found using web search engines and virtual assistants, and to assess the readability of the resulting information. Methods: Adolescent HIV prevention clinical experts developed a list of 23 prevention-related questions that were posed to search engines (Ask.com, Bing, Google, and Yahoo) and virtual assistants (Amazon Alexa, Microsoft Cortana, Google Assistant, and Apple Siri). The first three results from search engines and virtual assistant web references, as well as virtual assistant verbal responses, were recorded and coded using a six-tier scale to assess the quality of information produced. The results were also entered in a web-based tool determining readability using the Flesch-Kincaid Grade Level scale. Results: Google web search engine and Google Assistant more frequently produced PrEP information of higher quality than the other search engines and virtual assistants with scores ranging from 3.4 to 3.7 and 2.8 to 3.3, respectively. Additionally, the resulting information generally was presented in language at a seventh and 10th grade reading level according to the Flesch-Kincaid Grade Level scale. Conclusions: Adolescents and young adults are large consumers of technology and may experience discomfort discussing their sexual health with providers. It is important that efforts are made to ensure the information they receive about HIV prevention methods, and PrEP in particular, is comprehensive, comprehensible, and widely available. ",
doi="10.2196/41806",
url="https://pediatrics.jmir.org/2023/1/e41806",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463044"
}


@Article{info:doi/10.2196/47663,
author="Castor, Charlotte
and Lindkvist, Rose-Marie
and Hallstr{\"o}m, Kristensson Inger
and Holmberg, Robert",
title="Health Care Professionals' Experiences and Views of eHealth in Pediatric Care: Qualitative Interview Study Applying a Theoretical Framework for Implementation",
journal="JMIR Pediatr Parent",
year="2023",
month="Oct",
day="18",
volume="6",
pages="e47663",
keywords="communication",
keywords="digital",
keywords="experiences",
keywords="eHealth",
keywords="health care professionals",
keywords="implementation",
keywords="NASSS",
keywords="pediatric care",
abstract="Background: The development and evaluation of eHealth interventions in clinical care should be accompanied by a thorough assessment of their implementation. The NASSS (Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies) framework was designed to facilitate the implementation and scale-up of health technology programs, providing an option for analyzing the progression of these initiatives as they are implemented in real-time. Considering health care provider perspectives within the framework for implementation offers valuable insights into the early identification of barriers and facilitators in the implementation of potentially effective eHealth innovations. Nevertheless, there is a dearth of studies on eHealth interventions that encompass longer time frames and delve into the complexities of scaling up and sustaining such interventions within real-world health care environments. Objective: This study aims to investigate the perspectives and insights of health care professionals (HCPs) regarding the implementation of an eHealth intervention in pediatric health care while applying the NASSS framework to theorize and evaluate the conditions influencing the implementation of eHealth solutions. Methods: Semistructured interviews were performed with health care providers, including both staff and management personnel, within a university pediatric hospital (N=10). The data collection process occurred concurrently with a clinical trial focused on developing and assessing an eHealth app for self-management in pediatric care following hospital discharge. Using an abductive approach, the interviews were initially analyzed qualitatively and subsequently mapped onto the 7 domains of the NASSS framework to identify factors influencing implementation, encompassing facilitators, barriers, and varying levels of complexity. Results: In the realm of pediatric care, the family was identified as the primary unit of care, and patient heterogeneity was a prominent feature. The implementation of eHealth tools, while deemed usable and flexible, was also seen as a delicate balance between safety and adaptability, highlighting challenges related to health care integration. Child participation and secrecy, especially for adolescents, contributed to the complexity of using eHealth. HCPs had high eHealth literacy, and thus challenges concerning adoption were related to work adaptations and the risk of ``app overload.'' The readiness for implementation was experienced as induced through the research study and the pandemic situation. However, to move from research to implementation in clinical practice, organizational challenges identified a need to update the concept of care and ensure activity measurements. In a wider context, HCPs raised concerns related to regulatory requirements for documentation, public procurement, and data safety. Implementation became more complex due to a lack of overview in a large organization. Conclusions: Important perspectives for implementation were considerations of regulatory requirements, as well as the need for a shared vision of eHealth and the establishment of eHealth-related work as part of regular health care. Key contextual factors that support reach and impact are communication channels between different levels at the hospital and a need for paths and procedures compatible with legal, technological, and security concerns. Further research should focus on how eHealth interventions are perceived by children, adolescents, their parents, and other stakeholders. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/ct2/show/NCT04150120 ",
doi="10.2196/47663",
url="https://pediatrics.jmir.org/2023/1/e47663",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851500"
}


@Article{info:doi/10.2196/43160,
author="Shatwan, M. Israa
and Alhefani, S. Rabab
and Bukhari, F. Mawadah
and Hanbazazah, A. Danah
and Srour, K. Jumanah
and Surendran, Shelini
and Aljefree, M. Najlaa
and Almoraie, M. Noha",
title="Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="9",
volume="6",
pages="e43160",
keywords="smartphone app",
keywords="fruit and vegetable consumption",
keywords="Saudi Arabia",
keywords="adolescents",
keywords="nutrition",
keywords="health outcome",
keywords="digital health intervention",
keywords="digital health app",
keywords="pediatrics",
keywords="youth",
abstract="Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 ",
doi="10.2196/43160",
url="https://pediatrics.jmir.org/2023/1/e43160",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757770"
}


@Article{info:doi/10.2196/43814,
author="Shrestha, Manisha
and Bhandari, Gopal
and Kamalakannan, Sureshkumar
and Murthy, Satyanarayana Gudlavalleti Venkata
and Rathi, Kumar Suresh
and Gudlavalleti, Gaurang Anirudh
and Agiwal, Varun
and Pant, Hira
and Pandey, Binod
and Ghimire, Ramesh
and Ale, Daman
and Kayastha, Sajani
and Karki, Rakshya
and Chaudhary, Shankar Daya
and Byanju, Raghunandan
and ",
title="Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="23",
volume="6",
pages="e43814",
keywords="counseling",
keywords="follow-up",
keywords="intervention study",
keywords="Nepal",
keywords="ophthalmology",
keywords="pediatrics",
keywords="public health",
abstract="Background: Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions---(1) counseling and (2) SMS text messaging and phone calls---to improve the follow-up rates. Objective: This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods: A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results: The demographic characteristics of the participants were similar across the study groups. Only 3\% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76\% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions: We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): RR2-10.2196/31578 ",
doi="10.2196/43814",
url="https://pediatrics.jmir.org/2023/1/e43814",
url="http://www.ncbi.nlm.nih.gov/pubmed/36821366"
}


@Article{info:doi/10.2196/46152,
author="Lewkowitz, K. Adam
and Rubin-Miller, Lily
and Jahnke, R. Hannah
and Clark, A. Melissa
and Zlotnick, Caron
and Miller, S. Emily
and Henrich, Natalie",
title="Demographic and Support Interest Differences Among Nonbirthing Parents Using a Digital Health Platform With Parenthood-Related Anxiety: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="20",
volume="6",
pages="e46152",
keywords="nonbirthing parent",
keywords="paternal mental health",
keywords="perinatal anxiety",
keywords="parenting anxiety",
keywords="digital health",
keywords="anxiety",
keywords="perinatal",
keywords="mental health support",
keywords="digital platform",
keywords="pregnancy",
keywords="parents",
keywords="spouse",
keywords="partners",
keywords="support",
keywords="support groups",
keywords="online support",
abstract="Background: The transition to parenthood is a period of major stressors and increased risk of anxiety for all parents. Though rates of perinatal anxiety are similar among women (4\%-25\%) and men (3\%-25\%), perinatal anxiety research on nonbirthing partners remains limited. Objective: We aimed to examine whether demographic characteristics or digital perinatal support preferences differed among nonbirthing partners with compared to without self-reported high parenthood-related anxiety. Methods: In this large cross-sectional study of nonbirthing partners using a digital perinatal health platform during their partner's pregnancy, users reported their parenthood-related anxiety through a 5-item Likert scale in response to the prompt ``On a scale of 1=None to 5=Extremely, how anxious are you feeling about parenthood?'' High parenthood-related anxiety was defined as reporting being very or extremely anxious about parenthood. During the onboarding survey, in response to the question ``Which areas are you most interested in receiving support in?'' users selected as many support interests as they desired from a list of options. Chi-square and Fisher exact tests were used to compare demographic characteristics and support interests of nonbirthing partners with low versus high parenthood anxiety. Logistic regression models estimated the odds ratios (ORs), with 95\% CIs, of high parenthood-related anxiety with each user characteristic or digital support interest. Results: Among 2756 nonbirthing partners enrolled in the digital platform during their partner's pregnancy, 2483 (90.1\%) were men, 1668 (71.9\%) were first-time parents, 1159 (42.1\%) were non-Hispanic White, and 1652 (50.9\%) endorsed an annual household income of >US \$100,000. Overall, 2505 (91.9\%) reported some amount of parenthood-related anxiety, and 437 (15.9\%) had high parenthood-related anxiety. High parenthood-related anxiety was more common among non-White nonbirthing partners: compared to those who identified as non-Hispanic White, those who identified as Asian, Black, or Hispanic had 2.39 (95\% CI 1.85-3.08), 2.01 (95\% CI 1.20-3.23), and 1.68 (95\% CI 1.15-2.41) times the odds of high parenthood-related anxiety, respectively. Lower household income was associated with increased odds of reporting high parenthood anxiety, with the greatest effect among those with annual incomes of <US \$50,000 compared to >US \$100,000 (OR 2.13, 95\% CI 1.32-3.34). In general, nonbirthing partners were interested in receiving digital support during their partner's pregnancy, but those with high parenthood-related anxiety were more likely to desire digital support for all support interests compared to those without high parenthood anxiety. Those with high parenthood-related anxiety had more than 2 times higher odds of requesting digital education about their emotional health compared to those without high parenthood-related anxiety (OR 2.06, 95\% CI 1.67-2.55). Conclusions: These findings demonstrate the need for perinatal anxiety-related support for all nonbirthing partners and identify nonbirthing partners' demographic characteristics that increase the odds of endorsing high parenthood-related anxiety. Additionally, these findings suggest that most nonbirthing partners using a digital health platform with high parenthood-related anxiety desire to receive perinatal mental health support. ",
doi="10.2196/46152",
url="https://pediatrics.jmir.org/2023/1/e46152"
}


@Article{info:doi/10.2196/40561,
author="Haricharan, Jensen Hanne
and Hacking, Damian
and Lau, Kwan Yan
and Heap, Marion",
title="Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging--Based Information Campaign: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="22",
volume="6",
pages="e40561",
keywords="SMS text messages",
keywords="cell phones",
keywords="mobile health",
keywords="mHealth",
keywords="health information",
keywords="health literacy",
keywords="healthy behavior",
keywords="maternal health",
keywords="antenatal care",
keywords="Deaf",
keywords="South Africa",
abstract="Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging--based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants' knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging--based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women's knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people's health knowledge. However, attention should be paid to Deaf participants' specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe ",
doi="10.2196/40561",
url="https://pediatrics.jmir.org/2023/1/e40561",
url="http://www.ncbi.nlm.nih.gov/pubmed/37213174"
}


@Article{info:doi/10.2196/44701,
author="K{\"o}tting, Lukas
and Derksen, Christina
and Keller, Maria Franziska
and Lippke, Sonia",
title="Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="24",
volume="6",
pages="e44701",
keywords="Health Action Process Approach",
keywords="HAPA",
keywords="intention",
keywords="safe communication behavior",
keywords="patient safety",
keywords="obstetric patients",
keywords="digital intervention",
keywords="web-based app",
abstract="Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; $\eta$p2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 $\eta$p2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 ",
doi="10.2196/44701",
url="https://pediatrics.jmir.org/2023/1/e44701",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486755"
}


@Article{info:doi/10.2196/42272,
author="Champion, E. Katrina
and Hunter, Emily
and Gardner, A. Lauren
and Thornton, K. Louise
and Chapman, Cath
and McCann, Karrah
and Spring, Bonnie
and Slade, Tim
and Teesson, Maree
and Newton, C. Nicola",
title="Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents",
journal="JMIR Pediatr Parent",
year="2023",
month="Apr",
day="4",
volume="6",
pages="e42272",
keywords="parents",
keywords="adolescents",
keywords="prevention",
keywords="risk behaviors",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This study aimed to assess parents' knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods: An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents' perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results: A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1\% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4\%), vegetable intake (7/126, 5.6\%), and weekend recreational screen time (7/130, 5.4\%) was very low. Overall, parents' perceived knowledge of health guidelines was moderate, ranging from 50.6\% (80/158) for screen time to 72.8\% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2\% (46/104) and 42\% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1\%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7\% rated very or extremely important), and other important program features were ease of use (89/122, 72.9\%), paced learning (79/126, 62.7\%), and appropriate program length (74/126, 58.8\%). Conclusions: The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents. ",
doi="10.2196/42272",
url="https://pediatrics.jmir.org/2023/1/e42272",
url="http://www.ncbi.nlm.nih.gov/pubmed/37014696"
}


@Article{info:doi/10.2196/46966,
author="Ardesch, Hendrik Frank
and van der Vegt, Dorothy Denise
and Kiefte-de Jong, Christina Jessica",
title="Problematic Social Media Use and Lifestyle Behaviors in Adolescents: Cross-Sectional Questionnaire Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="28",
volume="6",
pages="e46966",
keywords="problematic social media use",
keywords="lifestyle factors",
keywords="adolescents",
keywords="lifestyle behaviors",
keywords="social media",
keywords="addictive social media use",
keywords="high school",
keywords="users",
keywords="risk factor",
keywords="sociodemographic factors",
keywords="addiction",
keywords="internet",
keywords="internet use",
keywords="social media use",
abstract="Background: The use of social media by adolescents has increased considerably in the past decade. With this increase in social media use in our daily lives, there has been a rapidly expanding awareness of the potential unhealthy lifestyle-related health effects arising from excessive, maladaptive, or addictive social media use. Objective: This study aims to assess the association between adolescents' social media use and health-related behaviors. Methods: We used a cross-sectional research approach and analyzed data from 96,919 adolescents at high schools throughout the Netherlands. A structured 43-item questionnaire was used to gather data on sociodemographics, dietary and lifestyle factors, and the degree of social media use based on the Compulsive Internet Use Scale. Logistic regression analyses were performed to assess the association between problematic social media use (PSMU) and lifestyle behaviors while adjusting for sociodemographic factors. Results: Of the 96,919 included adolescents, 7.4\% (n=7022) were identified as at risk for PSMU. Furthermore, logistic regression results showed that adolescents who are at risk for PSMU were more likely to report alcohol consumption and smoking while simultaneously having significantly lower levels of health-promoting behavior such as healthy eating habits (eating fruits, vegetables, and breakfast regularly) and physical activity. Conclusions: This study confirms that adolescents at risk of PSMU were more likely to exhibit an unhealthy lifestyle. Being at risk for PSMU was a determinant of soft drug use, alcohol consumption, smoking, poor eating habits, and lower physical activity independent of the additional adjusted covariates including demographic variables and remaining lifestyle variables. Future research is needed to confirm this observation in an experimental setting. ",
doi="10.2196/46966",
url="https://pediatrics.jmir.org/2023/1/e46966"
}


@Article{info:doi/10.2196/46365,
author="Cohen, Alyssa
and Bendelow, Anne
and Smith, Tracie
and Cicchetti, Colleen
and Davis, M. Matthew
and Heffernan, Marie",
title="Parental Attitudes on Social Media Monitoring for Youth: Cross-Sectional Survey Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="16",
volume="6",
pages="e46365",
keywords="social media",
keywords="bullying",
keywords="cyberbullying",
keywords="parenting",
keywords="pediatrics",
keywords="well-being",
keywords="wellbeing",
keywords="online",
keywords="monitoring",
keywords="youth",
keywords="internet safety",
keywords="parent",
keywords="survey",
keywords="internet",
keywords="mental health",
keywords="cross-sectional survey",
abstract="Background: Online environments dominate the daily lives of American youth and pose evolving challenges to their health and well-being. Recent national poll data indicate that social media overuse, internet safety, and online bullying are among parents' top child health concerns, particularly during the COVID-19 pandemic. While parents are uniquely positioned to help youth navigate social media, their attitudes on monitoring media use may be impacted by a myriad of personal and family factors. Objective: This study aimed to examine factors associated with parental attitudes about monitoring social media use among youth. Methods: Data were analyzed from the Voices of Child Health in Chicago Parent Panel Survey, administered to parents over the web and by telephone. Parents with at least 1 child aged ?11 years responded to questions about bullying and social media monitoring from May to July 2020. The primary outcome was their response to the following question: ``Do you think parents should monitor their children's use of social media platforms such as Facebook, Twitter, and Instagram?'' Bivariate analyses and multivariable logistic regression were used to examine parental agreement with frequent social media monitoring and concerns about bullying, adjusted for sociodemographic characteristics. Analyses were weighted to represent the parent population of Chicago. Results: Among 1613 survey respondents, the analyzed sample included 808 parents with at least 1 child aged ?11 years. Overall, 62.9\% (n=566) of parents agreed with frequent parental monitoring of their children's social media use. Compared with parents aged ?35 years, parents who were >35 years old were significantly less likely to agree with frequent social media monitoring (adjusted odds ratio [aOR] 0.45, 95\% CI 0.25-0.81). Parents expressing a high level of concern regarding the effects of bullying were more likely to agree with frequent monitoring of youth social media (aOR 2.15, 95\% CI 1.24-3.73). Conclusions: Parents' personal characteristics and concerns about bullying may influence their attitudes toward monitoring social media use among youth. Given the potential impact of these attitudes on parental monitoring behaviors and the subsequent health impact on youth, pediatricians should consider these factors when counseling about bullying and social media. Child health professionals can support families in developing a safe media use plan that fits family circumstances. ",
doi="10.2196/46365",
url="https://pediatrics.jmir.org/2023/1/e46365"
}


@Article{info:doi/10.2196/48012,
author="Frey, Erika
and Bonfiglioli, Catriona
and Frawley, Jane",
title="Parents' Use of Social Media for Health Information Before and After a Consultation With Health Care Professionals: Australian Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Oct",
day="20",
volume="6",
pages="e48012",
keywords="social media",
keywords="information seeking behavior",
keywords="parenting",
keywords="child",
keywords="infant",
keywords="health literacy",
keywords="patient education",
keywords="digital platform",
keywords="information",
keywords="health information",
keywords="public health",
abstract="Background: Social media is a crucial source of health information for many parents due to its integration into modern life, raising critical concerns for public health. Parents use various social media platforms to find health information for their children, with most information created and shared by parents with no medical or health training. The extent to which parents seek health information from social media before and after a consultation and their motivations for doing so remain underresearched. Objective: This study aimed to investigate Australian parents' use of social media for health information for their children, aged between 6 months and 5 years, before and after consulting with health care professionals. Methods: A representative cross-sectional survey of 1000 Australian parents with children aged 6 months to 5 years was conducted between November and December 2021. Data were cleaned and analyzed using IBM SPSS software. The primary outcomes were (1) parental motivation and prevalence of social media use for health information and (2) parental motivation for using social media before and after a consultation with their child's health care professional. Results: Of the 1000 parents surveyed, 82.2\% (n=822) reported using social media for health information for their child. Parents were more likely to consult social media before and after a health consultation if they were aged 30-39 or ?50 years and born in Australia. Parents with higher levels of education were less likely to consult social media. Parents were motivated to seek health information before a consultation for a variety of reasons, including exchanging opinions and experiences (639/767, 83.3\%), having information that is available 24/7 (622/767, 81.1\%), receiving emotional support (599/767, 78.1\%), having previous positive experiences (597/767, 77.8\%), and having friends and family that use social media for health information (577/767, 75.2\%). Parents sought information after a consultation to connect with parents with similar experiences (546/794, 68.8\%), seek a second opinion (505/794, 63.6\%), fact-check information provided by their health care professional (483/794, 60.8\%), and look for other treatment options (353/794, 44.5\%). Conclusion: Using social media for child health information is part of the modern parenting experience. It can be challenging to discern the quality of health information on social media, leaving parents open to incorrect information and misinformation. Although access to immediate social support is a welcomed feature of social media, receiving incorrect health information can have unwanted consequences for the child, family, health provider, and wider community. The upskilling of parental health literacy to navigate the unique health literacy challenges that social media brings, alongside the creation and delivery of accessible, evidence-based information in varying formats, is urgently required. The provision of this information is the responsibility of every level of the health system, not just the treating health care professional. ",
doi="10.2196/48012",
url="https://pediatrics.jmir.org/2023/1/e48012"
}


@Article{info:doi/10.2196/40371,
author="Bouchacourt, Lindsay
and Henson-Garci?a, Mike
and Sussman, Leah Kristen
and Mandell, Dorothy
and Wilcox, Gary
and Mackert, Michael",
title="Web-Based Conversations Regarding Fathers Before and During the COVID-19 Pandemic: Qualitative Content Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="15",
volume="6",
pages="e40371",
keywords="social media",
keywords="expecting fathers",
keywords="new fathers",
keywords="Twitter",
keywords="Reddit",
keywords="content analysis",
keywords="topic model",
keywords="topic analysis",
keywords="parent",
keywords="father",
abstract="Background: Studies of new and expecting parents largely focus on the mother, leaving a gap in knowledge about fathers. Objective: This study aimed to understand web-based conversations regarding new and expecting fathers on social media and to explore whether the COVID-19 pandemic has changed the web-based conversation. Methods: A social media analysis was conducted. Brandwatch (Cision) captured social posts related to new and expecting fathers between February 1, 2019, and February 12, 2021. Overall, 2 periods were studied: 1 year before and 1 year during the pandemic. SAS Text Miner analyzed the data and produced 47\% (9/19) of the topics in the first period and 53\% (10/19) of the topics in the second period. The 19 topics were organized into 6 broad themes. Results: Overall, 26\% (5/19) of the topics obtained during each period were the same, showing consistency in conversation. In total, 6 broad themes were created: fatherhood thoughts, fatherhood celebrations, advice seeking, fatherhood announcements, external parties targeting fathers, and miscellaneous. Conclusions: Fathers use social media to make announcements, celebrate fatherhood, seek advice, and interact with other fathers. Others used social media to advertise baby products and promote baby-related resources for fathers. Overall, the arrival of the COVID-19 pandemic appeared to have little impact on the excitement and resiliency of new fathers as they transition to parenthood. Altogether, these findings provide insight and guidance on the ways in which public health professionals can rapidly gather information about special populations---such as new and expecting fathers via the web---to monitor their beliefs, attitudes, emotional reactions, and unique lived experiences in context (ie, throughout a global pandemic). ",
doi="10.2196/40371",
url="https://pediatrics.jmir.org/2023/1/e40371",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790850"
}


@Article{info:doi/10.2196/38435,
author="Tenfelde, Kim
and Antheunis, Marjolijn
and Krahmer, Emiel
and Bunt, Erik Jan",
title="Using Digital Communication Technology to Improve Neonatal Care: Two-Part Explorative Needs Assessment",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="7",
volume="6",
pages="e38435",
keywords="mobile health",
keywords="mHealth",
keywords="physician-patient communication",
keywords="questions asking",
keywords="needs assessment",
keywords="explorative",
keywords="mobile phone",
abstract="Background: The birth of a premature infant and subsequent hospitalization are stressful events for parents. Therefore, accurate and easy-to-understand communication between parents and health care professionals is crucial during this period. Mobile health (mHealth) technologies have the potential to improve communication with parents at any time and place and possibly reduce their stress. Objective: We aimed to conduct a 2-part explorative needs assessment in which the interaction between the pediatrician and parents was examined along with their digital communication technology needs and interest in an mHealth app with the aim of improving interpersonal communication and information exchange. Methods: Overall, 19 consultations between parents of preterm infants and pediatricians were observed to determine which themes are discussed the most and the number of questions asked. Afterward, the parents and the pediatrician were interviewed to evaluate the process of communication and gauge their ideas about a neonatal communication mHealth app. Results: The observations revealed the following most prevalent themes: breastfeeding, criteria for discharge, medication, and parents' personal life. Interview data showed that the parents were satisfied with the communication with their pediatrician. Furthermore, both parents and pediatricians expected that a neonatal mHealth app could further improve the communication process and the hospital stay. Parents valued app features such as asking questions, growth graphs, a diary function, hospital-specific information, and medical rounds reports. Conclusions: Both parents of hospitalized preterm infants and pediatricians expect that the hypothetical mHealth app has the potential to cater to the most prevalent themes and improve communication and information exchange. Recommendations for developing such an app and its possible features are also discussed. On the basis of these promising results, it is suggested to further develop and study the effects of the mHealth app together with all stakeholders. ",
doi="10.2196/38435",
url="https://pediatrics.jmir.org/2023/1/e38435",
url="http://www.ncbi.nlm.nih.gov/pubmed/36749606"
}


@Article{info:doi/10.2196/46432,
author="Abdulhussein, S. Fatema
and Pinkney, Susan
and G{\"o}rges, Matthias
and van Rooij, Tibor
and Amed, Shazhan",
title="Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="13",
volume="6",
pages="e46432",
keywords="application design",
keywords="challenge",
keywords="child",
keywords="design",
keywords="development",
keywords="diabetes",
keywords="diabetic",
keywords="digital health",
keywords="digital solution",
keywords="engagement",
keywords="feature",
keywords="needs assessment",
keywords="patient engagement",
keywords="patient need",
keywords="pediatric",
keywords="perception",
keywords="privacy",
keywords="secure",
keywords="security",
keywords="trust",
keywords="Type 1 diabetes",
keywords="Type 1",
keywords="usage",
keywords="user centered",
keywords="user need",
keywords="youth",
abstract="Background: Digital health apps are becoming increasingly available for people living with diabetes, yet data silos continue to exist. This requires health care providers (HCPs) and patients to use multiple digital platforms to access health data. Objective: In this study, we gathered the perspectives of caregivers of children and youths living with type 1 diabetes (T1D) and pediatric diabetes HCPs in the user-centered design of TrustSphere, a secure, single-point-of-access, integrative digital health platform. Methods: We distributed web-based surveys to caregivers of children and youths living with T1D and pediatric diabetes HCPs in British Columbia, Canada. Surveys were designed using ordinal scales and had free-text questions. Survey items assessed key challenges, perceptions about digital trust and security, and potential desirable features for a digital diabetes platform. Results: Similar challenges were identified between caregivers of children and youths living with T1D (n=99) and HCPs (n=49), including access to mental health support, integration of diabetes technology and device data, and the ability to collaborate on care plans with their diabetes team. Caregivers and HCPs identified potential features that directly addressed their challenges, such as more accessible diabetes data and diabetes care plans. Caregivers had more trust in sharing their child's data digitally than HCPs. Most caregivers and HCPs stated that an integrative platform for T1D would support collaborative patient care. Conclusions: Caregiver and HCP perspectives gathered in this study will inform the early prototype of an integrative digital health platform. This prototype will be presented and iterated upon through a series of usability testing sessions with caregivers and HCPs to ensure the platform meets end users' needs. ",
doi="10.2196/46432",
url="https://pediatrics.jmir.org/2023/1/e46432",
url="http://www.ncbi.nlm.nih.gov/pubmed/37440296"
}


@Article{info:doi/10.2196/42461,
author="Nasruddin, Nasriah Nur Izzatun
and Murphy, Joey
and Armstrong, Glynis Miranda Elaine",
title="Physical Activity Surveillance in Children and Adolescents Using Smartphone Technology: Systematic Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Mar",
day="29",
volume="6",
pages="e42461",
keywords="physical activity",
keywords="surveillance",
keywords="children",
keywords="adolescents",
keywords="smartphone technology",
keywords="smartphone apps",
keywords="smartphone",
keywords="technology",
keywords="application",
keywords="database",
keywords="mobile phone",
abstract="Background: Self-reported physical activity (PA) questionnaires have traditionally been used for PA surveillance in children and adolescents, especially in free-living conditions. Objective measures are more accurate at measuring PA, but high cost often creates a barrier for their use in low- and middle-income settings. The advent of smartphone technology has greatly influenced mobile health and has offered new opportunities in health research, including PA surveillance. Objective: This review aimed to systematically explore the use of smartphone technology for PA surveillance in children and adolescents, specifically focusing on the use of smartphone apps. Methods: A literature search was conducted using 5 databases (PubMed, Scopus, CINAHL, MEDLINE, and Web of Science) and Google Scholar to identify articles relevant to the topic that were published from 2008 to 2023. Articles were included if they included children and adolescents within the age range of 5 to 18 years; used smartphone technology as PA surveillance; had PA behavioral outcomes such as energy expenditure, step count, and PA levels; were written in English; and were published between 2008 and 2023. Results: We identified and analyzed 8 studies (5 cross-sectional studies and 3 cohort studies). All participants were aged 12-18 years, and all studies were conducted in high-income countries only. Participants were recruited from schools, primary care facilities, and voluntarily. Five studies used mobile apps specifically and purposely developed for the study, whereas 3 studies used mobile apps downloadable from the Apple App Store and Android Play Store. PA surveillance using these apps was conducted from 24 hours to 4 weeks. Conclusions: Evidence of PA surveillance using smartphone technology in children and adolescents was insufficient, which demonstrated the knowledge gap. Additional research is needed to further study the feasibility and validity of smartphone apps for PA surveillance among children and adolescents, especially in low- and middle-income countries. ",
doi="10.2196/42461",
url="https://pediatrics.jmir.org/2023/1/e42461",
url="http://www.ncbi.nlm.nih.gov/pubmed/36989033"
}


@Article{info:doi/10.2196/44849,
author="Blok, J. David
and Simoski, Bojan
and van Woudenberg, J. Thabo
and Buijzen, Moniek",
title="The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="22",
volume="6",
pages="e44849",
keywords="agent-based modeling",
keywords="peer nomination network data",
keywords="physical activity",
keywords="social network analysis",
keywords="social network interventions",
keywords="web-based communication network data",
abstract="Background: Social network interventions are an effective approach to promote physical activity. These interventions are traditionally designed using self-reported peer nomination network data to represent social connections. However, there is unexplored potential in communication data exchanged through web-based messaging apps or social platforms, given the availability of these data, the developments in artificial intelligence to analyze these data, and the shift of personal communication to the web sphere. The implications of using web-based versus offline social networks on the effectiveness of social network interventions remain largely unexplored. Objective: This study aims to investigate the differences in the impact of social network interventions on physical activity levels (PALs) between networks derived from web-based communication and peer nomination data. Methods: We used the data on sociometric questionnaires, messages from a web-based communication app, and PAL (number of steps per day) of 408 participants in 21 school classes. We applied social network analysis to identify influential peers and agent-based modeling to simulate the diffusion of PAL and explore the impact of social network interventions on PAL among adolescents in school classes. Influential peers (n=63) were selected based on centrality measures (ie, in-degree, closeness, and betweenness) to spread the intervention. They received health education, which increased their PAL by 17\%. In sensitivity analyses, we tested the impact of a 5\%, 10\%, and 20\% increase in PAL among influential peers. Results: There was a 24\%-27\% overlap in selected influential peers between the 2 network representations. In general, the simulations showed that interventions could increase PAL by 5.0\%-5.8\% within 2 months. However, the predicted median impact on PAL was slightly higher in networks based on web-based communication data than peer nomination data for in-degree (5.7\%, IQR 5.5\%-6.1\% vs 5.5\%, IQR 5.2\%-5.8\%; P=.002), betweenness (5.6\%, IQR 5.4\%-5.9\% vs 5.0\%, IQR 4.7\%-5.3\%; P<.001), and closeness centrality (5.8\%, IQR 5.6\%-6.1\% vs 5.3\%, IQR 5.0\%-5.6\%; P<.001). A large variation in impact was observed between school classes (range 1.5\%-17.5\%). Lowering the effectiveness of health education from 17\% to 5\% would reduce the overall impact of the social network intervention by 3-fold in both networks. Conclusions: Our findings showed that network interventions based on web-based communication data could increase PAL. Web-based communication data may therefore be a valuable addition to peer nomination data for future social network intervention design. Artificial intelligence methods, including agent-based modeling, can help to design these network interventions and provide insights into the role of network characteristics in their effectiveness. ",
doi="10.2196/44849",
url="https://pediatrics.jmir.org/2023/1/e44849",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991813"
}


@Article{info:doi/10.2196/46154,
author="Huffman, Goodgame Landry
and Lawrence-Sidebottom, Darian
and Huberty, Jennifer
and Roots, Monika
and Roots, Kurt
and Parikh, Amit
and Guerra, Rachael
and Weiser, Jaclyn",
title="Using Digital Measurement--Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data",
journal="JMIR Pediatr Parent",
year="2023",
month="Apr",
day="20",
volume="6",
pages="e46154",
keywords="digital mental health intervention",
keywords="anxiety",
keywords="depression",
keywords="child",
keywords="adolescent",
keywords="collaborative care",
keywords="mental health",
keywords="caregiver",
keywords="pediatric",
keywords="youth",
keywords="demographic",
keywords="health outcome",
keywords="retrospective",
keywords="treatment",
keywords="e-mental health",
keywords="symptoms",
abstract="Background: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results: Among children and adolescents participating in care with Bend Health Inc, 73\% (72/98) exhibited improvements in anxiety symptoms and 73\% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement. Conclusions: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc. ",
doi="10.2196/46154",
url="https://pediatrics.jmir.org/2023/1/e46154",
url="http://www.ncbi.nlm.nih.gov/pubmed/37079366"
}


@Article{info:doi/10.2196/42349,
author="Beames, R. Joanne
and Werner-Seidler, Aliza
and Hodgins, Michael
and Brown, Lyndsay
and Fujimoto, Hiroko
and Bartholomew, Alexandra
and Maston, Kate
and Huckvale, Kit
and Zbukvic, Isabel
and Torok, Michelle
and Christensen, Helen
and Batterham, J. Philip
and Calear, L. Alison
and Lingam, Raghu
and Boydell, M. Katherine",
title="Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Jun",
day="12",
volume="6",
pages="e42349",
keywords="implementation",
keywords="youth",
keywords="digital",
keywords="depression",
keywords="secondary school",
keywords="qualitative",
keywords="consolidated framework for implementation research",
keywords="teacher",
keywords="educator",
keywords="perspective",
keywords="mental health",
keywords="student",
keywords="child",
keywords="adolescent",
keywords="adolescence",
keywords="school",
keywords="social work",
abstract="Background: Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. Objective: The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). Methods: Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. Results: Staff perceived the FPP as a novel (``innovative approach'') and appropriate way to address an unmet need within schools (``right place at the right time''). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution (``ways of working within schools''). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools (``reflecting on past experiences''). Conclusions: Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-042133 ",
doi="10.2196/42349",
url="https://pediatrics.jmir.org/2023/1/e42349",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307051"
}


@Article{info:doi/10.2196/47089,
author="LeStourgeon, Lauren
and Bergner, Erin
and Datye, Karishma
and Streisand, Randi
and Jaser, Sarah",
title="Evaluation of Study Engagement With an mHealth Intervention (THR1VE) to Treat Diabetes Distress in Teens With Type 1 Diabetes: Randomized Clinical Trial",
journal="JMIR Pediatr Parent",
year="2023",
month="Oct",
day="5",
volume="6",
pages="e47089",
keywords="type 1 diabetes mellitus",
keywords="positive psychology",
keywords="adolescents",
keywords="parental positive messaging",
keywords="mHealth",
keywords="engagement",
keywords="diabetes",
keywords="distress",
keywords="teens",
keywords="chronic health conditions",
keywords="sex",
keywords="age",
keywords="device",
keywords="race",
keywords="ethnicity",
keywords="text",
keywords="mobile health",
abstract="Background: Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. Objective: This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. Methods: Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. Results: Adolescents in both groups reported high levels of satisfaction with the study, with 95\% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5\% of intervention messages, and their caregivers responded to 88.5\% of messages. There were no significant differences in rates of engagement related to adolescents' sex, age, device use, or race/ethnicity. Conclusions: A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination. Trial Registration: ClinicalTrials.gov NCT03845465; https://clinicaltrials.gov/study/NCT03845465 ",
doi="10.2196/47089",
url="https://pediatrics.jmir.org/2023/1/e47089"
}


@Article{info:doi/10.2196/52364,
author="Garner, Katie
and Thabrew, Hiran
and Lim, David
and Hofman, Paul
and Jefferies, Craig
and Serlachius, Anna",
title="Exploring the Usability and Acceptability of a Well-Being App for Adolescents Living With Type 1 Diabetes: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="22",
volume="6",
pages="e52364",
keywords="well-being",
keywords="digital health interventions",
keywords="type 1 diabetes",
keywords="diabetes",
keywords="diabetic",
keywords="adolescent",
keywords="youth",
keywords="adolescents",
keywords="young people",
keywords="parents",
keywords="parent",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="acceptability",
keywords="usability",
keywords="interview",
keywords="interviews",
keywords="opinion",
keywords="opinions",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Adolescents living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) have an increased risk of psychological disorders due to the demands of managing a chronic illness and the challenges of adolescence. Psychological disorders during adolescence increase the risk of suboptimal glycemic outcomes and may lead to serious diabetes-related complications. Research shows that digital health interventions may increase access to psychological support for adolescents and improve physical and mental health outcomes for youth with diabetes. To our knowledge, there are no evidence-based, publicly available mental health apps with a focus on improving the psychological well-being of adolescents with diabetes. Objective: This study aimed to explore the acceptability and usability of our evidence-based well-being app for New Zealand adolescents, Whitu: 7 Ways in 7 Days (Whitu), to allow us to further tailor it for youth with diabetes. We interviewed adolescents with T1D and T2D, their parents, and health care professionals to explore their views on the Whitu app and suggestions for tailoring the app for adolescent with diabetes. We also explored the cultural acceptability of the Whitu app for M?ori and Pacific adolescents. Methods: A total of 34 participants, comprising 13 adolescents aged 12-16 years (11 with T1D and 2 with T2D), 10 parents, and 11 health care professionals, were recruited from a specialist diabetes outpatient clinic and Facebook diabetes groups. Each participant attended one 1-hour focus group on Zoom, in person, or via phone. Researchers gathered general feedback on what makes an effective and engaging app for adolescents with diabetes, as well as specific feedback about Whitu. Transcribed audio recordings of the focus groups were analyzed using directed content analysis. Results: Adolescents with T1D, their parents, and health care professionals found Whitu to be acceptable and usable. Adolescents with T1D and their parents signaled a preference for more diabetes-specific content. Health care professionals expressed less awareness and trust of digital health interventions and, as such, recommended that they be used with external support. Due to challenges in recruitment and retention, we were unable to include the views of adolescents with T2D in this qualitative study. Conclusions: There appears to be sufficient openness to the use of an app such as Whitu for supporting the well-being of adolescents with T1D, albeit with modifications to make its content more diabetes specific. Based on this qualitative study, we have recently developed a diabetes-specific version of Whitu (called LIFT: Thriving with Diabetes). We are also planning a qualitative study to explore the views of youth with T2D and their perspectives on the new LIFT app, where we are using alternative research approaches to recruit and engage adolescents with T2D and their families. ",
doi="10.2196/52364",
url="https://pediatrics.jmir.org/2023/1/e52364"
}


@Article{info:doi/10.2196/48924,
author="Annesi, Thomas
and Steinway, Caren
and Oluwole, Toyosi
and Shilly, Steffi
and Szalda, Dava
and Myers, Regina
and Chen, Jack
and Jan, Sophia",
title="Quality of Web-Based Sickle Cell Disease Resources for Health Care Transition: Website Content Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="13",
volume="6",
pages="e48924",
keywords="sickle cell",
keywords="health care transition",
keywords="readability",
keywords="Flesch Reading Ease",
keywords="health care information",
keywords="adulthood",
keywords="sickle cell disease",
keywords="online resource",
keywords="quality",
keywords="adolescent",
keywords="transition",
keywords="health care service",
keywords="website quality",
keywords="online information",
keywords="Ensuring Quality Information for Patients",
keywords="EQIP",
keywords="FRE",
abstract="Background: Adolescents and young adults with sickle cell disease (SCD) transitioning from pediatric to adult health care face a high-risk period associated with increased use of acute health care services and mortality. Although 59\% of American citizens report using the internet for health care information, the quality of web-based, patient-facing resources regarding transition in SCD care has not been evaluated. Objective: This study aimed to evaluate the quality and readability of web-based health information on SCD, especially as it pertains to the transition to adulthood for inidividuals with SCD. The study also compared the readability and content scores of websites identified in 2018 to those from 2021 to assess any change in quality over time. Methods: Keywords representing phrases adolescents may use while searching for information on the internet regarding transition in SCD care, including ``hydroxyurea'' and ``SCD transition,'' were identified. A web-based search using the keywords was conducted in July 2021 using Google, Yahoo, and Bing. The top 20 links from each search were collected. Duplicate websites, academic journals, and websites not related to SCD health care transition were excluded. Websites were categorized based on the source: health department, hospital or private clinician, professional society, and other websites. Websites were assessed using Health On the Net Foundation code of conduct (HONcode), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FGL), Ensuring Quality Information for Patients (EQIP), and a novel SCD content checklist (SCDCC). EQIP and SCDCC scores range from 0- to 100. Each website was reviewed by 2 research assistants and assessed for interrater reliability. Descriptive statistics were calculated. Results: Of the 900 websites collected, 67 (7.4\%) met the inclusion criteria: 13 health department, 7 hospital or private clinician, 33 professional society, and 14 other websites. A total of 15 (22\%) out of 67 websites had HONcode certification. Websites with HONcode certification had higher FRE and EQIP scores and lower FGL scores than those without HONcode certification, reflecting greater readability. Websites without HONcode certification had higher SCDCC scores, reflecting greater clinical content. Only 7 (10\%) websites met the National Institutes of Health recommendation of a seventh-grade or lower reading level. Based on EQIP scores, 6 (9\%) websites were of high quality. The mean SCDCC score was 20.60 (SD 22.14) out of 100. The interrater reliability for EQIP and SCDCC ratings was good (intraclass correlation: 0.718 and 0.897, respectively). No source of website scored significantly higher mean EQIP, FRE, FGL, or SCDCC scores than the others (all P<.05). Conclusions: Although seeking health care information on the web is very common, the overall quality of information about transition in SCD care on the internet is poor. Changes to current web-based health care information regarding SCD care transitions would benefit transitioning youth by providing expectations, knowledge, skills, and tools to increase self-efficacy. ",
doi="10.2196/48924",
url="https://pediatrics.jmir.org/2023/1/e48924"
}


@Article{info:doi/10.2196/32282,
author="Bocqu{\'e}, Catheline
and Wang, Jingyun
and Rickmann, Annekatrin
and Julich-Haertel, Henrike
and Kaempf, Uwe
and Januschowski, Kai",
title="Gamification to Support Adherence to a Therapeutic Ambylopia Treatment for Children: Retrospective Study Using a Focal Ambient Visual Acuity Stimulation Game",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="1",
volume="6",
pages="e32282",
keywords="amblyopia",
keywords="children",
keywords="compliance",
keywords="adherence",
keywords="occlusion",
keywords="patching",
keywords="therapeutic game",
keywords="FAVAS",
abstract="Background: The gold standard treatment for amblyopia is patching the better eye. Improvement of visual acuity in the amblyopic eye is significantly impacted by the adherence to the patching therapy. It is known that the overall adherence is rather low. Objective: This retrospective study evaluated whether an updated version of attention-binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in improved patient adherence in 4- to 16-year-old patients with amblyopia associated with anisometropia or strabismus. Methods: We analyzed electronically pseudonymized recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older version (2015) and the other group used a newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the number of minutes using the therapeutic games as monitored in the automatized logbook versus the prescribed number of minutes for using the games. Results: Children in group 2015 (n=138) spent on average 2009.3 (SD 1372.1; range 36-5556) minutes using FAVAS; children in group 2020 (n=129) spent on average 2651.2 (SD 1557.1; range 38-5672) minutes using the newer version. Group 2020 spent on average 641.9 more minutes on FAVAS than group 2015 (t255.49=3.56, P<.001, d=0.45; 95\% CI 0.69-0.20). Although patient adherence was very variable, compared to the 55.0\% (SD 29.4\%) in group 2015, it significantly improved up to 68.5\% (SD 33.7\%) in group 2020 (t254.38=3.48, P=.001, d=0.44; 95\% CI 0.68-0.19). Conclusions: FAVAS 2020, with improved gamification aspect as well as tablet computer functionality, increased adherence significantly compared to the earlier version of FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. Trial Registration: German Clinical Trials Register (DRKS) DRKS00017633; https://drks.de/search/de/trial/DRKS00017633 ",
doi="10.2196/32282",
url="https://pediatrics.jmir.org/2023/1/e32282",
url="http://www.ncbi.nlm.nih.gov/pubmed/36724007"
}


@Article{info:doi/10.2196/42399,
author="de la Vega, Rocio
and Palermo, M. Tonya",
title="Mediating Role of Treatment Perceptions in the Relationship Between Individual Characteristics and Engagement With a Digital Psychological Intervention for Pediatric Chronic Pain: Secondary Data Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Mar",
day="6",
volume="6",
pages="e42399",
keywords="treatment adherence",
keywords="treatment perceptions",
keywords="mediators",
keywords="pediatric pain",
keywords="psychological intervention",
keywords="digital health",
keywords="treatment",
keywords="intervention",
keywords="engagement",
keywords="self-management",
keywords="psychological",
abstract="Background: Engagement predicts benefits from self-managed treatments. However, engagement is an important concern in digital interventions, with over 50\% of patients being nonadherent to interventions in chronic conditions such as chronic pain. Little is known about the individual characteristics that contribute to engagement with a digital self-management treatment. Objective: This study tested the mediating role of treatment perceptions (difficulty and helpfulness) in the association between individual baseline characteristics (treatment expectancies and readiness to change) and treatment engagement (online and offline) with a digital psychological intervention for adolescents with chronic pain. Methods: A secondary data analysis of a single-arm trial of Web-based Management of Adolescent Pain, a self-guided internet intervention developed for the management of chronic pain in adolescents, was conducted. Survey data were collected at baseline (T1), midtreatment (ie, 4 weeks after the treatment started; T2), and post treatment (T3). Online engagement was assessed using back-end information on the number of days adolescents accessed the treatment website, while the offline engagement was assessed with the reported frequency of use of skills (ie, pain management strategies) learned at the end of the treatment. Four parallel multiple mediator linear regression models, using ordinary least square regression incorporating the variables were tested. Results: In total, 85 adolescents with chronic pain (12-17 years old, 77\% female) participated. Several mediation models were significant in predicting online engagement. A significant indirect effect was found for the path expectancies--helpfulness--online engagement (effect 0.125; SE 0.098; 95\% CI 0.013-0.389) and for the path precontemplation--helpfulness--online engagement (effect ?1.027; SE 0.650; 95\% CI ?2.518 to ?0.054). Fourteen percent of the variance of online engagement was explained by the model including expectancies as a predictor (F3=3.521; P<.05), whereas 15\% was explained by the model where readiness to change was the predictor (F3=3.934; P<.05). Offline engagement was partially explained in the model including readiness to change as the predictor but with marginal significance (F3=2.719; R2=0.111; P=.05). Conclusions: Treatment perception, specifically, perceived helpfulness, was a mediator of the pathway between both treatment expectancies and readiness to change and online engagement with a digital psychological intervention for chronic pain. Assessing these variables at baseline and midtreatment may help to determine the risk of nonadherence. Further work is needed to confirm these mediation pathways in larger samples. Trial Registration: ClinicalTrials.gov NCT04043962; https://clinicaltrials.gov/ct2/show/NCT04043962 ",
doi="10.2196/42399",
url="https://pediatrics.jmir.org/2023/1/e42399",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877543"
}


@Article{info:doi/10.2196/39720,
author="Bui, An Truong
and Rosenfelt, Scott Cory
and Whitlock, Hope Kerri
and Leclercq, Mickael
and Weber, Savannah
and Droit, Arnaud
and Wiebe, A. Sandra
and Pei, Jacqueline
and Bolduc, V. Francois",
title="Long-term Memory Testing in Children With Typical Development and Neurodevelopmental Disorders: Remote Web-based Image Task Feasibility Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="8",
volume="6",
pages="e39720",
keywords="memory",
keywords="neurodevelopmental disorder",
keywords="autism spectrum disorder",
keywords="intellectual disability",
keywords="developmental delay",
keywords="hippocampus",
keywords="recognition",
keywords="paired association learning",
keywords="remote testing",
keywords="autism",
keywords="disorder",
keywords="genetics",
keywords="developmental",
keywords="developmental disorder",
keywords="game",
keywords="remote",
keywords="testing",
keywords="diagnose",
keywords="diagnosis",
abstract="Background: Neurodevelopmental disorders (NDD) cause individuals to have difficulty in learning facts, procedures, or social skills. NDD has been linked to several genes, and several animal models have been used to identify potential therapeutic candidates based on specific learning paradigms for long-term and associative memory. In individuals with NDD, however, such testing has not been used so far, resulting in a gap in translating preclinical results to clinical practice. Objective: We aim to assess if individuals with NDD could be tested for paired association learning and long-term memory deficit, as shown in previous animal models. Methods: We developed an image-based paired association task, which can be performed at different time points using remote web-based testing, and evaluated its feasibility in children with typical development (TD), as well as NDD. We included 2 tasks: object recognition as a simpler task and paired association. Learning was tested immediately after training and also the next day for long-term memory. Results: We found that children aged 5-14 years with TD (n=128) and with NDD of different types (n=57) could complete testing using the Memory Game. Children with NDD showed deficits in both recognition and paired association tasks on the first day of learning, in both 5-9--year old (P<.001 and P=.01, respectively) and 10-14--year old groups (P=.001 and P<.001, respectively). The reaction times to stimuli showed no significant difference between individuals with TD or NDD. Children with NDD exhibited a faster 24-hour memory decay for the recognition task than those with TD in the 5-9--year old group. This trend is reversed for the paired association task. Interestingly, we found that children with NDD had their retention for recognition improved and matched with typically developing individuals by 10-14 years of age. The NDD group also showed improved retention deficits in the paired association task at 10-14 years of age compared to the TD group. Conclusions: We showed that web-based learning testing using simple picture association is feasible for children with TD, as well as with NDD. We showed how web-based testing allows us to train children to learn the association between pictures, as shown in immediate test results and those completed 1 day after. This is important as many models for learning deficits in NDD target both short- and long-term memory for therapeutic intervention. We also demonstrated that despite potential confounding factors, such as self-reported diagnosis bias, technical issues, and varied participation, the Memory Game shows significant differences between typically developing children and those with NDD. Future experiments will leverage this potential of web-based testing for larger cohorts and cross-validation with other clinical or preclinical cognitive tasks. ",
doi="10.2196/39720",
url="https://pediatrics.jmir.org/2023/1/e39720",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155237"
}


@Article{info:doi/10.2196/44252,
author="Blake, V. Kathryn
and Antal, Holly
and Bunnell, Timothy H.
and He, Jiaxian
and Henderson, Robert
and Holbrook, T. Janet
and McCahan, M. Suzanne
and Pennington, Chris
and Rogers, Linda
and Shade, David
and Sugar, A. Elizabeth
and Taylor, Alexandra
and Wise, A. Robert
and Wysocki, Tim",
title="Comprehension by Caregivers and Adolescents of Clinical Trial Information Delivered via Multimedia Video Versus Conventional Practice: Nonrandomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2023",
month="Jun",
day="22",
volume="6",
pages="e44252",
keywords="adolescent",
keywords="clinical trial",
keywords="comprehension",
keywords="informed consent",
keywords="internet",
keywords="multimedia",
abstract="Background: Research participants often misunderstand the required elements of informed consent information, whether provided in written or oral format. Informed consent instruments with embedded evidence-based learning theory principles administered in multimedia electronic formats may improve comprehension and retention. Objective: This study aims to determine whether study information comprehension and retention using an interactive multimedia video consent process was noninferior to comprehension and retention after an in-person face-to-face interaction with a conventional written consent document for caregivers and adolescents enrolled in a clinical trial. Methods: Participants were caregivers and children aged 12 to 17 years who were enrolled in a clinical trial of asthma treatment. Consent information was presented as a multimedia web-based video consent interaction or as a conventional written consent document with in-person interaction between the prospective participants and the study staff. The trial used a parallel nonrandomized noninferiority design that compared the 2 consent methods. Caregivers and adolescents completed a 17-item open-ended comprehension questionnaire (score range 17-51) at enrollment and at the end of the study 20 weeks later. Comprehension and retention were compared between the consent formats. Noninferiority was established if the 95\% CI upper bound of the difference in scores (conventional format minus web-based) was less than the noninferiority margin of 2.4; superiority was established if the upper bound of the CI was <0. Results: In total, 54 caregiver and adolescent dyads completed the interactive multimedia web-based video consent, and 25 dyads completed the conventional consent. Overall, 33\% (26/79) of all adolescents were Black, 57\% (45/79) were male, and 61\% (48/79) had a household income of <US \$60,000 per year. For caregivers, the interactive multimedia web-based format was noninferior to the conventional format at enrollment (difference between the conventional and web-based formats: mean ?0.30, 95\% CI ?2.52 to 1.92) and was superior at the end of the study 20 weeks later (mean ?2.20, 95\% CI ?3.9 to ?0.5). There was a loss of comprehension over 20 weeks (mean ?1.65, 95\% CI ?3.1 to ?0.19) with the conventional format but not with the multimedia web-based format (mean 0.14, 95\% CI ?0.84 to 1.12). For adolescents, the noninferiority of the multimedia web-based format was not established. Conclusions: Caregivers who are considering enrolling their adolescent in an asthma clinical trial have similar comprehension of study information when delivered through an interactive multimedia web-based platform, which incorporates evidence-based learning theory principles, compared with having a conventional in-person, face-to-face discussion. The retention of study information over time was better with the multimedia format for caregivers. Trial Registration: ClinicalTrials.gov NCT02061280; https://clinicaltrials.gov/ct2/show/NCT02061280 and NCT01437995; https://clinicaltrials.gov/ct2/show/NCT01437995 ",
doi="10.2196/44252",
url="https://pediatrics.jmir.org/2023/1/e44252",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347518"
}


@Article{info:doi/10.2196/43214,
author="Shouldice, Claire Ainslie
and Beatty, Madison
and Adams, Sherri
and Dharmaraj, Blossom
and Moore, Clara
and Stinson, Nan Jennifer
and Desai, Arti
and Bartlett, Leah
and Culbert, Erin
and Cohen, Eyal
and Orkin, Julia",
title="Caregivers' Experiences With a Web- and Mobile-Based Platform for Children With Medical Complexity and the Role of a Live Platform Coach: Thematic Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="5",
volume="6",
pages="e43214",
keywords="care coordination",
keywords="care",
keywords="children with medical complexity",
keywords="children",
keywords="chronic condition",
keywords="electronic data",
keywords="engagement",
keywords="health information exchange",
keywords="medical",
keywords="patient care planning",
keywords="pediatrics",
keywords="usage",
keywords="utilization",
abstract="Background: Children with medical complexity (CMC) are individuals with complex chronic conditions who have substantial health care needs, functional limitations, and significant use of health care. By nature of their health status, they have many care providers across multiple settings, making information sharing critical to their health and safety. Connecting2gether (C2), a web- and mobile-based patient-facing platform, was codeveloped with families to support and empower parental caregivers, improve information sharing, and facilitate care delivery. C2 also provided a live platform coach to conduct parental feedback and coaching sessions, which included answering questions, providing advice on usage, and addressing technological issues. Objective: This study was conducted to understand the experience of parental caregivers using the C2 platform and the role of the live platform coach. This study is a subset of a larger study assessing the feasibility of C2 in the care of CMC. Methods: Parental caregivers (n=33) participated in biweekly sessions to provide feedback and receive real-time platform use support from a trained research team member acting as a live platform coach. Parental caregivers were asked about the utility and usability of C2's features. Questions, platform issues, and feedback were recorded on a standardized electronic data collection tool. A thematic analysis was performed to analyze parental comments, and codes were categorized into key themes. The number of comments corresponding with each code was quantified. Results: A total of 166 parental feedback and coaching sessions were conducted, with an average of 5 sessions per parental caregiver (range 1-7). There were 33 (85\%) parental caregivers that participated in at least one coaching session. Technical issues and difficulties navigating C2 were addressed in real time during the sessions to encourage platform engagement. Four key themes were identified: (1) live platform coach, (2) barriers to platform usage and technical challenges, (3) platform requests and modifications, and (4) parent partnership and empowerment. Conclusions: Parental caregivers describe C2 as a valuable tool, acting as a facilitator for enhanced care coordination and communication. Parental caregiver feedback showed that the live platform coach was a critical tool in educating on platform use and addressing technological concerns. Further study of the use of the C2 platform and its role in the care of CMC is needed to understand the possible benefits and cost-effectiveness of this technology. ",
doi="10.2196/43214",
url="https://pediatrics.jmir.org/2023/1/e43214",
url="http://www.ncbi.nlm.nih.gov/pubmed/37405834"
}


@Article{info:doi/10.2196/41393,
author="Babayan, Katherine
and Keilty, Krista
and Esufali, Jessica
and Grajales III, J. Francisco
and ",
title="An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="8",
volume="6",
pages="e41393",
keywords="children with medical complexity",
keywords="technology dependence",
keywords="medical devices",
keywords="family caregivers",
keywords="virtual care",
keywords="home and community care",
keywords="emergency department visits",
keywords="enteral feeding tubes",
keywords="hospital-to-home transition",
keywords="feasibility",
keywords="mixed methods",
abstract="Background: Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. Objective: This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto's Hospital for Sick Children (SickKids). Methods: This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids' electronic medical records (Epic) with a chief complaint of ``medical device problems,'' after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. Results: A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51\% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to ``medical device problems'' over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6\%), with 41.6\% (57/137) assessed as virtually manageable. Conclusions: Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits. ",
doi="10.2196/41393",
url="https://pediatrics.jmir.org/2023/1/e41393",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938869"
}


@Article{info:doi/10.2196/40269,
author="Siddiqi, Arif Danya
and Ali, Feroz Rozina
and Shah, Taighoon Mubarak
and Dharma, Kumar Vijay
and Khan, Ali Anokhi
and Roy, Tapash
and Chandir, Subhash",
title="Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="17",
volume="6",
pages="e40269",
keywords="missed opportunities for vaccination",
keywords="mobile-based immunization decision support system",
keywords="catch-up immunizations",
abstract="Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization--recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators' understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8\% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8\% (17,378/17,961) of all immunization doses. A total of 3.2\% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. ",
doi="10.2196/40269",
url="https://pediatrics.jmir.org/2023/1/e40269",
url="http://www.ncbi.nlm.nih.gov/pubmed/36800221"
}


@Article{info:doi/10.2196/47334,
author="Ou, Lihong
and Chen, Chia-Chen Angela
and Amresh, Ashish",
title="The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="21",
volume="6",
pages="e47334",
keywords="human papillomavirus",
keywords="mobile health",
keywords="mHealth",
keywords="parents",
keywords="systematic review",
keywords="vaccination",
keywords="youth",
keywords="mobile phone",
abstract="Background: The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine's proven efficacy, the vaccination rate among US youth remains below the recommended 80\% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. Objective: This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth's vaccine uptake. Methods: We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. Results: Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82\%), used a randomized controlled trial design (12/17, 71\%), and adopted behavior change theories or a culture-centric approach (10/17, 59\%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone?apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88\% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12\% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. Conclusions: This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations. ",
doi="10.2196/47334",
url="https://pediatrics.jmir.org/2023/1/e47334",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988155"
}


@Article{info:doi/10.2196/49521,
author="Meng, Glen
and Jan Ali, Maliha
and Tse, Man Sze",
title="Caregivers' Perceptions, Needs, and Data Sharing Concerns in mHealth Research on Pediatric Asthma: Cross-Sectional Survey Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="19",
volume="6",
pages="e49521",
keywords="asthma",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="application",
keywords="apps",
keywords="applications",
keywords="pediatrics",
keywords="caregivers",
keywords="knowledge translation",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="respiratory",
keywords="pulmonary",
keywords="lung",
keywords="pediatric",
keywords="data sharing",
keywords="information sharing",
keywords="privacy",
keywords="usability",
keywords="confidentiality",
keywords="child",
keywords="children",
keywords="caregiver",
keywords="caregiving",
keywords="patient knowledge",
abstract="Background: Pediatric asthma is the most common chronic respiratory disease of childhood. Caregivers often report lacking knowledge in several aspects of asthma management at home. Although the use of mobile health (mHealth) tools, such as mobile apps, could facilitate asthma self-management and, simultaneously, the collection of data for research, few studies have explored the features that caregivers would like to see in such a tool and their perceptions on data sharing. Objective: This study evaluates caregivers' perceived knowledge gaps in asthma management; their perceptions of certain features and resources that should be included in a potential mobile app; and any concerns that they may have regarding data sharing for research, including privacy and security concerns. Methods: In this cross-sectional study, we surveyed 200 caregivers of children (aged 1-13 y) with asthma who were followed at a pediatric tertiary care center in Montreal, Canada. Anonymous data were collected through the institutional web-based survey platform. We collected the participants' answers by using a 5-category Likert scale (``completely agree,'' ``agree,'' ``neither agree nor disagree,'' ``disagree,'' and ``completely disagree''), multiple-choice questions, and free-text questions on the abovementioned topics. Descriptive statistics were performed, and answers were compared between caregivers of preschool-aged children and caregivers of school-aged children. Results: Participating children`s mean age was 5.9 (SD 3.4) years, with 54\% (108/200) aged ?5 years and 46\% (92/200) aged >6 years. Overall, caregivers reported having adequate knowledge about asthma and asthma self-management. Nonetheless, they identified several desirable features for a mobile app focused on asthma self-management. The most frequently identified features included receiving alerts about environmental triggers of asthma (153/199, 76.9\%), having videos that demonstrate symptoms of asthma (133/199, 66.8\%), and being able to log children's asthma action plans in the app (133/199, 66.8\%). Interestingly, more caregivers of preschool-aged children preferred textual information when compared to caregivers of school-aged children (textual information for explaining asthma: P=.008; textual information for the symptoms of asthma: P=.005). Caregivers were generally highly in favor of sharing data collected through a mobile app for research. Conclusions: Caregivers of children with asthma in our study identified several desirable educational and interactive features that they wanted to have in a mobile app for asthma self-management. These findings provide a foundation for designing and developing mHealth tools that are relevant to caregivers of children with asthma. ",
doi="10.2196/49521",
url="https://pediatrics.jmir.org/2023/1/e49521"
}


@Article{info:doi/10.2196/48822,
author="Kan, Kristin
and Morales, Lu
and Shah, Avani
and Simmons, Emily
and Barrera, Leonardo
and Massey, Liana
and List, Greta
and Gupta, S. Ruchi",
title="Digital Technology Characteristics and Literacy Among Families With Children With Asthma: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="29",
volume="6",
pages="e48822",
keywords="pediatric asthma",
keywords="digital literacy",
keywords="health equity",
keywords="equity",
keywords="asthma",
keywords="respiration",
keywords="respiratory",
keywords="pulmonary",
keywords="child",
keywords="children",
keywords="youth",
keywords="survey",
keywords="surveys",
keywords="disparity",
keywords="disparities",
keywords="socio-demographic",
keywords="sociodemographic",
keywords="use",
keywords="technology use",
keywords="self-management",
keywords="family",
abstract="Background: The use of digital technology in pediatric asthma management has emerged as a potential tool for improving asthma management. However, the use of digital tools has the potential to contribute to the inequitable delivery of asthma care because of existing social factors associated with asthma disparities. Our study focused on parents' chosen language and sociodemographic factors that might shape the use of digital technology in asthma self-management. Objective: This study aims to estimate and compare patient, family, and technology-related characteristics by parents' chosen language (English or Spanish) and compare a digital literacy measure by sociodemographic factors. Methods: Survey data were collected from July to December 2021 from parents of children with asthma who were seen by a Chicago pediatric health system pulmonary provider. Questions assessed patient and family characteristics, digital technology use, and digital literacy, measured using the validated eHealth Literacy Scale (eHEALS). Chi-square tests and multivariable logistic regression were used for comparisons, and Kruskal-Wallis tests were used for comparing median eHEALS scores by social characteristics. Results: Of the 197 parents surveyed, 24.4\% (n=49) of parents identified as a race categorized as other, 37.1\% (n=67) as White, and 38.6\% (n=75) as Black; 47.2\% (n=93) identified as Hispanic/Latino/Latina. Additionally, 79.7\% (n=157) of parents preferred English, and 20.3\% (n=40) preferred Spanish. English-speaking parents were more likely to report having a data plan for their smartphone (117/157, 74.5\%) or high-speed internet (138/157, 87.9\%) compared to Spanish-speaking parents (smartphone: 23/40, 58\%; P=.03; internet: 27/40, 68\%; P=.002). Compared with Spanish-speaking parents, English-speaking parents were less likely to report having a lot or some concern about paying for internet (28/40, 70\% vs 83/157, 52.9\%; P=.046) or about data privacy (35/40, 88\% vs 105/157, 67.5\%; P=.01). Digital literacy scores differed significantly by race, income, education level, and language. In a multivariable model, language was not a significant factor for having high-speed internet service (P=.12) or concern about paying for internet at home (P=.60), but it was a significant factor for concerns about data privacy (P=.04). Conclusions: The significant differences in technology-related characteristics suggest that digital connectivity, affordability, and data privacy may also be important factors in considering digital technology use in asthma care. ",
doi="10.2196/48822",
url="https://pediatrics.jmir.org/2023/1/e48822"
}


@Article{info:doi/10.2196/40231,
author="O'Connor, Antonia
and Tai, Andrew
and Brinn, Malcolm
and Hoang, Hien Amy Nguyen Thuc
and Cataldi, Daniele
and Carson-Chahhoud, Kristin",
title="The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jan",
day="13",
volume="6",
pages="e40231",
keywords="asthma",
keywords="asthma education",
keywords="pediatric asthma",
keywords="augmented reality",
keywords="mobile phone",
abstract="Background: Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92\% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. Objective: The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). Methods: An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. Results: Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users' value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. Conclusions: AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 ",
doi="10.2196/40231",
url="https://pediatrics.jmir.org/2023/1/e40231",
url="http://www.ncbi.nlm.nih.gov/pubmed/36637889"
}


@Article{info:doi/10.2196/40219,
author="O'Connor, Antonia
and Tai, Andrew
and Brinn, Malcolm
and Hoang, Hien Amy Nguyen Thuc
and Cataldi, Daniele
and Carson-Chahhoud, Kristin",
title="Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="25",
volume="6",
pages="e40219",
keywords="asthma",
keywords="asthma education",
keywords="pediatric",
keywords="pediatric asthma",
keywords="co-design",
keywords="usability",
keywords="development",
keywords="smartphone",
keywords="tablet",
keywords="augmented reality",
keywords="health education",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Smartphone and tablet apps that deliver health care education have been identified as effective in improving patient knowledge and treatment adherence in asthma populations. Despite asthma being the most common chronic disease in pediatrics, there are few apps that are targeted specifically for children. Only half of children with asthma have acceptable control of their symptoms, and 40\%-98\% do not use their inhalers correctly. With children being increasingly connected to technology, there is an opportunity to improve asthma inhaler technique education by delivery via smartphone or tablet apps. Augmented reality (AR) technology was used in this study to capitalize on growing technological innovations. Digital health interventions that use a co-design process for development have the highest likelihood of successful uptake and effectiveness on their intended outcomes. Perceived usability also has been shown to improve the effectiveness of education as well as the acceptance of the intervention. Objective: The aims of this study were to describe the co-design process, development, and design outcomes of a smartphone or tablet app that incorporates AR technology to deliver asthma inhaler technique education to children with asthma. This study also aimed to provide a usability evaluation, using the System Usability Scale to inform our work and future research, and recommendations for others performing similar work. Methods: The development of the AR asthma inhaler technique education app was based on an iterative co-design process with likely end users (children with asthma, their caregivers, and health care professionals). This involved multiple stages: recruitment of end users for qualitative interviews and usability testing with a previously designed educational intervention, which used an AR-embedded smartphone or tablet app; ideation of content for a specific asthma inhaler technique education intervention with end users; development of the specific asthma inhaler intervention; and 2 further rounds of interviews and usability testing with the redesign of the initial prototype. Results: We included 16 participants aged 9-45 years. Using the co-design process, the AR asthma inhaler technique education app was designed, incorporating the preferences of end users. After iteration 1, animation was included based on the feedback provided. Iteration 2 feedback resulted in increased AR experiences and the removal of the requirement of a paper-based resource to trigger AR in the third iteration. Throughout all rounds, the ease of use of the app and the novel nature of the intervention were frequently described. The usability of the intervention overall was perceived to be excellent, and the mean System Usability Scale score of the intervention was found to be highest in the final round of evaluation (90.14). Conclusions: The results from this co-design process and usability evaluation will be used to develop a final AR asthma inhaler technique educational intervention, which will be evaluated in the clinical setting. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 ",
doi="10.2196/40219",
url="https://pediatrics.jmir.org/2023/1/e40219",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490325"
}


@Article{info:doi/10.2196/50765,
author="Nissen, Michael
and Perez, A. Carlos
and Jaeger, M. Katharina
and Bleher, Hannah
and Flaucher, Madeleine
and Huebner, Hanna
and Danzberger, Nina
and Titzmann, Adriana
and Pontones, A. Constanza
and Fasching, A. Peter
and Beckmann, W. Matthias
and Eskofier, M. Bjoern
and Leutheuser, Heike",
title="Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="15",
volume="6",
pages="e50765",
keywords="maternity log",
keywords="maternity logbook",
keywords="log",
keywords="logbook",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="opinions",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="pregnancy record",
keywords="personal health record",
keywords="PHR",
keywords="health records",
keywords="health record",
keywords="feature",
keywords="features",
keywords="develop",
keywords="development",
keywords="maternity record",
keywords="electronic",
keywords="digital",
keywords="paper hand-held record",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="smartphone",
keywords="smartphones",
keywords="wearable",
keywords="wearables",
keywords="usability",
keywords="pregnant",
keywords="pregnancy",
keywords="maternal",
keywords="maternity",
keywords="electronic maternity record",
keywords="pregnancy app",
keywords="data sharing",
keywords="privacy",
keywords="online search",
keywords="searching",
keywords="information behavior",
keywords="information behaviour",
keywords="information seeking",
abstract="Background: Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study. Objective: The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy. Methods: A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective. Results: A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated ``above average'' in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes. Conclusions: Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects. ",
doi="10.2196/50765",
url="https://pediatrics.jmir.org/2023/1/e50765"
}


@Article{info:doi/10.2196/53933,
author="Balsam, Donna
and Bounds, T. Dawn
and Rahmani, M. Amir
and Nyamathi, Adeline",
title="Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="25",
volume="6",
pages="e53933",
keywords="mindfulness app",
keywords="pregnancy",
keywords="pregnant",
keywords="maternal",
keywords="obstetric",
keywords="obstetrics",
keywords="stress",
keywords="anxiety",
keywords="heart rate variability",
keywords="mindfulness",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="mental health",
keywords="meditation",
keywords="mind-body",
keywords="complementary",
keywords="alternative",
keywords="heart rate",
keywords="sleep",
keywords="mobile phone",
abstract="Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant's levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13\% (P=.006). A total of 65\%  of study participants (n=13) reported their sleep improved during the trial, and 95\% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100\%, with 65\% of participants (n=13) completing about two-thirds of the intervention, and 50\% of participants (n=10) completing ?95\%. Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy. ",
doi="10.2196/53933",
url="https://pediatrics.jmir.org/2023/1/e53933",
url="http://www.ncbi.nlm.nih.gov/pubmed/38145479"
}


@Article{info:doi/10.2196/47552,
author="Legge, A. Alexandra
and Middleton, L. Jennifer
and Reid, Shelley
and Gordon, Adrienne",
title="Implementation of a Web Camera System in an Australian Neonatal Intensive Care Unit: Pre- and Postevaluation of the Parent and Staff Experience",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="22",
volume="6",
pages="e47552",
keywords="web camera",
keywords="telehealth",
keywords="telemedicine",
keywords="neonate",
keywords="neonatology",
keywords="NICU",
keywords="virtual visitation",
keywords="implementation",
keywords="Australia",
keywords="prematurity",
keywords="illness",
keywords="newborns",
keywords="parent-infant separation",
keywords="stress",
keywords="parental",
keywords="engagement",
keywords="neonatal intensive care unit",
abstract="Background: Admission to a neonatal intensive care unit (NICU) for prematurity or illness is necessary for approximately 20\% of newborns in Australia, resulting in parent-infant separation. Web cameras in the NICU provide a virtual link for parents to remain remotely connected to their infant during admission. Web camera use is increasing; however, there is limited evidence on the impact of web cameras on parents, infants, and neonatal staff. Objective: There were two objectives: (1) to determine the attitudes of parents and staff toward web cameras in the NICU and (2) to compare parental depression, anxiety, and stress levels using validated scales before and after web camera implementation in the NICU. Methods: A pre- and postevaluation survey was administered before and after implementation of the NICVIEW camera system in a tertiary NICU in Sydney, Australia. The NICVIEW camera system provides secure real-time viewing of infants and can be accessed from any device with an internet connection. Surveys were administered to parents of inpatients and staff, and included open- and closed-ended questions and Likert scales. Survey questions aimed to determine parent and staff attitudes and use of web cameras before and after implementation. In addition, pre- and postimplementation parental levels of depression, anxiety, and stress, as measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21) and Parental Stressor Scale: Neonatal Intensive Care Unit, were recorded. Results: In total, 94 parents and 109 staff members completed the pre- and postimplementation surveys. Post implementation, 43 of 44 (98\%) parents supported web cameras, and 40 of 42 (95\%) parents stated that they used web cameras. The most common reasons for support from parents included web cameras making parents feel more at ease, facilitating parent-infant bonding, increasing parental confidence in staff, and allowing others to see infants. There was no significant difference between the parental groups for the depression, anxiety, or stress scales measured by DASS-21. Staff support for web cameras increased significantly from 34 of 42 (81\%) participants before to 64 of 67 (96\%) participants after implementation (P=.01). Following implementation, there was a resolution in staff concerns about web cameras having an adverse impact on staff roles and privacy and security concerns. Conclusions: Web camera use in a tertiary Australian NICU was strongly supported by parents and staff and may reduce parental stress, facilitate parent-infant bonding, and encourage positive parent-staff engagement. Web cameras are a feasible method of providing continuity of care for families and should be considered as a standard of care in similarly resourced settings. ",
doi="10.2196/47552",
url="https://pediatrics.jmir.org/2023/1/e47552"
}


@Article{info:doi/10.2196/40463,
author="Aune, Anders
and Vartdal, Gunnar
and Jimenez Diaz, Gabriela
and Gierman, Marijn Lobke
and Bergseng, H{\aa}kon
and Darj, Elisabeth",
title="Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="28",
volume="6",
pages="e40463",
keywords="neonatal jaundice",
keywords="neonatal hyperbilirubinemia",
keywords="newborns",
keywords="mobile app",
keywords="design",
keywords="validation",
keywords="regulatory processes",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformit{\'e} Europ{\'e}enne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94\%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 {\textmu}mol/L, and maintained a high specificity (71\%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. ",
doi="10.2196/40463",
url="https://pediatrics.jmir.org/2023/1/e40463",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853753"
}


@Article{info:doi/10.2196/37359,
author="Mwenda, Valerian
and Makena, Ireen
and Ogweno, Vincent
and Obonyo, James
and Were, Vincent",
title="The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="1",
volume="6",
pages="e37359",
keywords="text messages",
keywords="adolescent pregnancy",
keywords="milestones",
keywords="mHealth",
keywords="psychosocial support",
keywords="Kenya",
keywords="nurturing care",
abstract="Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8\% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5\% vs 112/220, 50.9\%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4\% vs 112/220, 50.9\%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse ",
doi="10.2196/37359",
url="https://pediatrics.jmir.org/2023/1/e37359",
url="http://www.ncbi.nlm.nih.gov/pubmed/37126373"
}


@Article{info:doi/10.2196/43867,
author="Mehdizadeh, Hamed
and Asadi, Farkhondeh
and Nazemi, Eslam
and Mehrvar, Azim
and Yazdanian, Azade
and Emami, Hassan",
title="A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Mar",
day="30",
volume="6",
pages="e43867",
keywords="Digital health",
keywords="eHealth",
keywords="Telehealth",
keywords="mHealth",
keywords="Mobile app",
keywords="self-management",
keywords="cancer",
keywords="child",
keywords="parent",
keywords="caregiver",
keywords="usability evaluation",
abstract="Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children's evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD   0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. ",
doi="10.2196/43867",
url="https://pediatrics.jmir.org/2023/1/e43867",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995746"
}


@Article{info:doi/10.2196/38236,
author="Movahed, Mehrnoosh
and Rue, Ishana
and Yoo, Yejong Paul
and Sogomonian, Tamara
and Majnemer, Annette
and Shikako, Keiko",
title="Characteristics of Inclusive Web-Based Leisure Activities for Children With Disabilities: Qualitative Descriptive Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="4",
volume="6",
pages="e38236",
keywords="children with disabilities",
keywords="social inclusion",
keywords="participation",
keywords="accessibility",
keywords="leisure",
keywords="web-based activities",
keywords="pandemic",
abstract="Background: The participation of children with disabilities in leisure activities is a key determinant of their physical and mental health. The COVID-19 pandemic has limited participation in leisure activities for all children, particularly those with disabilities. As a result, children with disabilities may be less active while feeling more isolated and stressed. Web-based communities and activities have become increasingly important. Understanding how web-based activities include or exclude children with disabilities can contribute to the development of inclusive communities that may support participation after the pandemic. Objective: This study aimed to identify factors that may facilitate or prevent the participation of children with disabilities in web-based leisure activities. Methods: We adopted a qualitative descriptive interpretative methodology and conducted interviews with 2 groups of participants: service providers offering inclusive web-based leisure activities and parents of children with disabilities who have engaged in web-based leisure activities during the COVID-19 pandemic. A semistructured interview format was created based on the Theoretical Domains Framework. The questions focused on the description of the web-based activities offered by the service provider (eg, age range, frequency, cost, target population, and type of activity offered) and any adaptations to make the web-based activity accessible to children and youth with disabilities, and their perceptions and beliefs about what supported or deterred participation in the activities. Results: A total of 17 participants described their experiences in participating in and creating web-based leisure programs and the factors preventing or facilitating children's participation in web-based activities. Environment and context factors included accommodations, the format of activities and the web-based setting, stakeholder involvement, and materials and resources available. Activities that had flexible schedules, both recorded and live options for joining, and that provided clear instructions and information were perceived as more accessible. Beliefs involved the characteristics of the child and the family environment, as well as the characteristics of the organizations providing the activity. Activity facilitators who were familiar with the web-based environment and knew the specific characteristics of the child facilitated their participation. Engagement in community champions and respect for children's individual preferences were perceived as positive. Access to technology, funding, and caregivers' ability to facilitate child engagement are crucial factors that must be considered when offering web-based programs. Conclusions: Web-based environments offer an accessible and safe option for leisure participation when public health conditions prevent children with disabilities from participating in in-person activities. However, to make web-based activities accessible to children with a variety of disabilities, there needs to be a clear plan toward universal web-based accessibility that accounts for individual needs and collective approaches to web-based leisure. Future work should consider developing and testing guidelines for web-based accessibility, equity, public policy, and programming considerations in offering these activities for all children. ",
doi="10.2196/38236",
url="https://pediatrics.jmir.org/2023/1/e38236",
url="http://www.ncbi.nlm.nih.gov/pubmed/36668903"
}


@Article{info:doi/10.2196/44920,
author="Lebby, R. Stephanie
and Shyam, Sangeetha
and Ramadas, Amutha
and Bohm, R. Andrew
and Hill, C. Julia
and Fortuna, L. Karen
and Zoltick, R. Stephanie",
title="Prospective Association Between Video and Computer Game Use During Adolescence and Incidence of Metabolic Health Risks: Secondary Data Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="6",
volume="6",
pages="e44920",
keywords="video games",
keywords="obesity",
keywords="pediatrics",
keywords="computer games",
keywords="portable device",
keywords="teenager",
keywords="adolescents",
keywords="health data",
keywords="BMI",
keywords="diabetes",
keywords="high blood pressure",
keywords="high cholesterol",
keywords="metabolic disorder",
abstract="Background: Video and computer games are popular activities, with 72\% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video and computer games on adolescents. Objective: The objective of this study was to examine the prevalence of video and computer game use among US adolescents and rates of positive screens for obesity, diabetes, high blood pressure (BP), and high cholesterol. Methods: A secondary data analysis was conducted using the National Longitudinal Study of Adolescent to Adult Health (Add Health) data, including adolescents aged 12 to 19 years between 1994 and 2018. Results: Respondents (n=4190) who played the most video and computer games had a significantly (P=.02) higher BMI and were more likely to self-report having at least one of the evaluated metabolic disorders: obesity (BMI >30 kg/m2), diabetes, high BP (BP >140/90), and high cholesterol (>240). With increased video or computer game use, there was a statistically significant increase in high BP rates in each quartile, with those with more frequent use also having higher rates of high BP. A similar trend was observed for diabetes, though the association did not reach statistical significance. No significant association was observed between video or computer game use and diagnoses of dyslipidemia, eating disorders, or depression. Conclusions: Frequency of video and computer game use is associated with obesity, diabetes, high BP, and high cholesterol in adolescents aged 12 to 19 years. Adolescents who play the most video and computer games have a significantly higher BMI. They are more likely to have at least one of the evaluated metabolic disorders: diabetes, high BP, or high cholesterol. Public health interventions designed to target modifiable disease states through health promotion and self-management may support the health of adolescents aged 12 to 19 years. Video and computer games can integrate health promotion interventions in gameplay. This is an important area for future research as video and computer games are integrated into the lives of adolescents. ",
doi="10.2196/44920",
url="https://pediatrics.jmir.org/2023/1/e44920",
url="http://www.ncbi.nlm.nih.gov/pubmed/37410530"
}


@Article{info:doi/10.2196/46785,
author="Wood, D. Michael
and West, C. Nicholas
and Fokkens, Christina
and Chen, Ying
and Loftsgard, C. Kent
and Cardinal, Krystal
and Whyte, D. Simon
and Portales-Casamar, Elodie
and G{\"o}rges, Matthias",
title="An Individualized Postoperative Pain Risk Communication Tool for Use in Pediatric Surgery: Co-Design and Usability Evaluation",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="17",
volume="6",
pages="e46785",
keywords="eHealth",
keywords="risk communication",
keywords="decision aid",
keywords="pain",
keywords="individualized risk",
keywords="surgery",
keywords="anesthesia",
keywords="postoperative",
keywords="risk",
keywords="co-design",
keywords="focus group",
keywords="requirement definition",
keywords="prototyping",
keywords="usability",
keywords="prototype",
keywords="child",
keywords="pediatric",
keywords="decision support",
keywords="iterative",
abstract="Background: Risk identification and communication tools have the potential to improve health care by supporting clinician-patient or family discussion of treatment risks and benefits and helping patients make more informed decisions; however, they have yet to be tailored to pediatric surgery. User-centered design principles can help to ensure the successful development and uptake of health care tools. Objective: We aimed to develop and evaluate the usability of an easy-to-use tool to communicate a child's risk of postoperative pain to improve informed and collaborative preoperative decision-making between clinicians and families. Methods: With research ethics board approval, we conducted web-based co-design sessions with clinicians and family participants (people with lived surgical experience and parents of children who had recently undergone a surgical or medical procedure) at a tertiary pediatric hospital. Qualitative data from these sessions were analyzed thematically using NVivo (Lumivero) to identify design requirements to inform the iterative redesign of an existing prototype. We then evaluated the usability of our final prototype in one-to-one sessions with a new group of participants, in which we measured mental workload with the National Aeronautics and Space Administration (NASA) Task Load Index (TLX) and user satisfaction with the Post-Study System Usability Questionnaire (PSSUQ). Results: A total of 12 participants (8 clinicians and 4 family participants) attended 5 co-design sessions. The 5 requirements were identified: (A) present risk severity descriptively and visually; (B) ensure appearance and navigation are user-friendly; (C) frame risk identification and mitigation strategies in positive terms; (D) categorize and describe risks clearly; and (E) emphasize collaboration and effective communication. A total of 12 new participants (7 clinicians and 5 family participants) completed a usability evaluation. Tasks were completed quickly (range 5-17 s) and accurately (range 11/12, 92\% to 12/12, 100\%), needing only 2 requests for assistance. The median (IQR) NASA TLX performance score of 78 (66-89) indicated that participants felt able to perform the required tasks, and an overall PSSUQ score of 2.1 (IQR 1.5-2.7) suggested acceptable user satisfaction with the tool. Conclusions: The key design requirements were identified, and that guided the prototype redesign, which was positively evaluated during usability testing. Implementing a personalized risk communication tool into pediatric surgery can enhance the care process and improve informed and collaborative presurgical preparation and decision-making between clinicians and families of pediatric patients. ",
doi="10.2196/46785",
url="https://pediatrics.jmir.org/2023/1/e46785",
url="http://www.ncbi.nlm.nih.gov/pubmed/37976087"
}


@Article{info:doi/10.2196/43961,
author="Alatorre, Selenne
and Schwarz, G. Aviva
and Egan, A. Kelsey
and Feldman, R. Amanda
and Rosa, Marielis
and Wang, L. Monica",
title="Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="8",
volume="6",
pages="e43961",
keywords="social media",
keywords="adolescents of color",
keywords="obesity disparities",
keywords="disparity",
keywords="disparities",
keywords="healthy weight management",
keywords="health education",
keywords="child health",
keywords="mHealth",
keywords="mobile health",
keywords="weight",
keywords="obese",
keywords="obesity",
keywords="child",
keywords="pediatric",
keywords="adolescent",
keywords="adolescence",
keywords="preference",
keywords="health behavior",
keywords="mobile phone",
abstract="Background: Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity. Objective: This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media. Methods: This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach. Results: A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet. Conclusions: Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media--based interventions to engage adolescents of color in healthy weight management content. ",
doi="10.2196/43961",
url="https://pediatrics.jmir.org/2023/1/e43961",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155230"
}


@Article{info:doi/10.2196/36132,
author="Kulandaivelu, Yalinie
and Hamilton, Jill
and Banerjee, Ananya
and Gruzd, Anatoliy
and Patel, Barkha
and Stinson, Jennifer",
title="Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="20",
volume="6",
pages="e36132",
keywords="adolescents",
keywords="digital health intervention",
keywords="food literacy",
keywords="health literacy",
keywords="nutrition",
keywords="peer education",
keywords="peer support",
keywords="social media",
abstract="Background: Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media--based nutrition education interventions to inform the implementation of future social media--based nutrition education interventions. Objective: A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions for adolescents was conducted. Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions was extracted. Results: A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied. Conclusions: Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media--based nutrition interventions and the need for user-centered design of the interventions. ",
doi="10.2196/36132",
url="https://pediatrics.jmir.org/2023/1/e36132",
url="http://www.ncbi.nlm.nih.gov/pubmed/37471119"
}


@Article{info:doi/10.2196/47358,
author="Kuschke, Silva
and Moodie, Sheila
and Kirubalingam, Keshinisuthan
and O'Hagan, Robin
and Glista, Danielle",
title="Parents' Perceptions of the Factors Influencing the Uptake of Remote Pediatric Hearing Aid Support: Development of a Conceptual Framework",
journal="JMIR Pediatr Parent",
year="2023",
month="Jun",
day="6",
volume="6",
pages="e47358",
keywords="audiology",
keywords="care",
keywords="child engagement",
keywords="children",
keywords="concept mapping",
keywords="cost",
keywords="hearing aid",
keywords="hearing loss",
keywords="hearing",
keywords="integration",
keywords="parents",
keywords="pediatric audiology",
keywords="pediatric",
keywords="remote hearing aid support",
keywords="support",
keywords="virtual care",
abstract="Background: To achieve effective integration of virtual care into family-centered audiology practices, participatory research methods, including parents as vital participants in the delivery of pediatric audiology care, should be considered. A better understanding of the barriers and facilitators influencing the adoption of virtual care for families is warranted. Objective: This study aimed to develop a conceptual framework of the factors perceived to influence the adoption of remote pediatric hearing aid support among the parents of children with hearing loss. Methods: A total of 12 parents of children who wear hearing aids, between the ages of 0-17 years, were recruited to participate in group or individual interviews as part of the 6-step participatory-based concept mapping (CM) process. Data collection was specific to parents in a Canadian context. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: The CM process resulted in 6 main themes, displayed in a cluster map according to their order of importance. These themes include access to timely, consistent care; technology considerations; convenience; child engagement; cost; and partnership considerations. Key underlying statements and subthemes are highlighted per theme. Conclusions: Findings from this study demonstrate the use of CM in participatory research with parents and as part of a family-centered care model. Future research should aim to investigate the factors that influence the uptake of remote hearing aid support in different contexts, for example, in low- to middle-income countries versus those in high-income countries. ",
doi="10.2196/47358",
url="https://pediatrics.jmir.org/2023/1/e47358",
url="http://www.ncbi.nlm.nih.gov/pubmed/37279061"
}


@Article{info:doi/10.2196/40940,
author="Albayrak, Bilge
and Cordier, Jane Larissa
and Greve, Sandra
and Teschler, Uta
and Dathe, Anne-Kathrin
and Felderhoff-M{\"u}ser, Ursula
and H{\"u}ning, Maria Britta",
title="Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Jan",
day="25",
volume="6",
pages="e40940",
keywords="COVID-19",
keywords="very preterm infant",
keywords="video consultation",
keywords="follow-up care",
keywords="COVID-19 pandemic",
keywords="neurodevelopmental outcome",
abstract="Background: During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children's development. Objective: To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. Methods: An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children's behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. Results: There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=--0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child's development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5\%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73\%) attended a follow-up appointment, of which 117 (14.9\%) were video consultations. Conclusions: The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away. ",
doi="10.2196/40940",
url="https://pediatrics.jmir.org/2023/1/e40940",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409307"
}


@Article{info:doi/10.2196/42378,
author="Kahn, F. Nicole
and Anan, H. Yomna
and Bocek, M. Kevin
and Christakis, A. Dimitri
and Richardson, P. Laura
and Pratt, Wanda
and Sequeira, M. Gina",
title="Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="14",
volume="6",
pages="e42378",
keywords="transgender and gender diverse youth",
keywords="adolescent",
keywords="telemedicine",
keywords="gender-affirming care",
keywords="qualitative methods",
keywords="COVID-19",
keywords="pandemic",
keywords="youth",
keywords="gender",
keywords="care",
keywords="technical",
keywords="implementation",
keywords="transgender",
keywords="gender diverse",
keywords="complexity",
abstract="Background: Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. Objective: The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. Methods: Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. Results: A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. Conclusions: Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care. ",
doi="10.2196/42378",
url="https://pediatrics.jmir.org/2023/1/e42378",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745775"
}


@Article{info:doi/10.2196/41554,
author="Kodjebacheva, Damianova Gergana
and Culinski, Taylor
and Kawser, Bushra
and Coffer, Katelynn",
title="Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature",
journal="JMIR Pediatr Parent",
year="2023",
month="Apr",
day="27",
volume="6",
pages="e41554",
keywords="satisfaction",
keywords="pediatrics",
keywords="telehealth",
keywords="telemedicine",
keywords="virtual care",
keywords="caregivers",
keywords="patients",
keywords="children",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="technology use",
keywords="caregiver",
keywords="adolescent",
keywords="youth",
keywords="satisfaction survey",
keywords="health outcome",
keywords="review methodology",
keywords="systematic review",
abstract="Background: Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services. Objective: This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services. Methods: We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. Results: All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits. Conclusions: In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care. ",
doi="10.2196/41554",
url="https://pediatrics.jmir.org/2023/1/e41554",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000504"
}


@Article{info:doi/10.2196/47035,
author="Kostyrka-Allchorne, Katarzyna
and Chu, Petrina
and Ballard, Claire
and Lean, Nancy
and French, Blandine
and Hedstrom, Ellen
and Byford, Sarah
and Cortese, Samuele
and Daley, David
and Downs, Johnny
and Glazebrook, Cristine
and Goldsmith, Kimberley
and Hall, L. Charlotte
and Kovshoff, Hanna
and Kreppner, Jana
and Sayal, Kapil
and Shearer, James
and Simonoff, Emily
and Thompson, Margaret
and Sonuga-Barke, S. Edmund J.",
title="Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Sep",
day="11",
volume="6",
pages="e47035",
keywords="parenting intervention",
keywords="mobile app",
keywords="attention-deficit/hyperactivity disorder",
keywords="ADHD",
keywords="behavior problems",
keywords="mobile health",
keywords="mHealth",
keywords="children",
keywords="usability",
keywords="mobile phone",
abstract="Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants' recruitment and the app's usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients' data. Parents' and clinicians' feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6\%) via myHealthE and 3 (2.4\%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9\%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75\%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65\% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84\%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95\% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS' usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 ",
doi="10.2196/47035",
url="https://pediatrics.jmir.org/2023/1/e47035",
url="http://www.ncbi.nlm.nih.gov/pubmed/37695667"
}


@Article{info:doi/10.2196/46982,
author="Valla, Lisbeth
and Haga, Marie Silje
and Garthus-Niegel, Susan
and Drozd, Filip",
title="Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="22",
volume="6",
pages="e46982",
keywords="perinatal depression",
keywords="internet intervention",
keywords="dropout",
keywords="well-being",
keywords="perinatal period",
abstract="Background: The perinatal period is a vulnerable time when women are at increased risk of depression. ``Mamma Mia'' is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported. Objective: The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase. Methods: A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50\%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50\%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach. Results: The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program. Conclusions: There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined. ",
doi="10.2196/46982",
url="https://pediatrics.jmir.org/2023/1/e46982"
}


@Article{info:doi/10.2196/40937,
author="Mancinelli, Elisa
and Dell'Arciprete, Gaia
and Pattarozzi, Davide
and Gabrielli, Silvia
and Salcuni, Silvia",
title="Digital Behavioral Activation Interventions During the Perinatal Period: Scoping Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="28",
volume="6",
pages="e40937",
keywords="behavioral activation",
keywords="eHealth",
keywords="perinatal care",
keywords="depression symptoms",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Pregnancy is a complex period that implies many biopsychosocial changes, and the way women adapt to these changes impacts their well-being and the chances of developing mental health problems. During the perinatal period, women have expressed a preference for support delivered on the web. In this regard, interventions such as behavioral activation (BA), which are brief and structured psychosocial interventions, seem particularly suited to be delivered through digital solutions. Objective: This study aimed to map the literature investigating digital BA interventions deployed during the perinatal period. We paid particular attention to the methodological underpinnings of the studies, the potential impact of BA interventions on symptoms other than depression, and the existence of differences occurring when these interventions were administered during pregnancy versus the postpartum period. Methods: A systematic search compliant with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines was conducted considering 5 bibliographic databases; reference lists and key journals were also screened by 2 independent authors following a double-blind approach. Results: A total of 7 studies published between 2013 and 2022 were included. In total, 2 studies were protocols for randomized controlled trials, 5 were empirical studies, and 1 was a qualitative study. All studies focused on the postpartum period, except for 1 that focused on the broader perinatal period. Promising effects on depression symptoms were reported but not on other psychosocial symptoms. Low intervention adherence has emerged, whereas the usability associated with the digital means used to deploy interventions was scarcely addressed; moreover, information on the digital platforms used was poorly reported overall. Conclusions: Our findings highlight the scarcity and preliminary nature of digital BA interventions deployed during the perinatal period, where the focus seems more on treatment rather than prevention. Moreover, future studies should also consider and address usability and user engagement, given their relevance to intervention efficacy. ",
doi="10.2196/40937",
url="https://pediatrics.jmir.org/2023/1/e40937",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853756"
}


@Article{info:doi/10.2196/45616,
author="Cluxton-Keller, Fallon
and Olson, Ardis",
title="A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Apr",
day="13",
volume="6",
pages="e45616",
keywords="anxiety",
keywords="depression",
keywords="family treatment",
keywords="infant care",
keywords="maternal health",
keywords="parenting",
keywords="pediatric primary care",
keywords="perinatal anxiety",
keywords="perinatal care",
keywords="perinatal depression",
keywords="video therapy",
keywords="women's health",
abstract="Background: Untreated perinatal depression and anxiety can have detrimental consequences on family function. Logistical barriers prevent many perinatal women from accessing treatment, and these barriers are compounded for women residing in rural areas. This paper describes a Family-Based Collaborative Care Model (FBCCM) that is designed to bypass barriers to increase access to care for depressed and anxious perinatal women in rural regions of the United States. The FBCCM includes the following two components: (1) a 10-session video-delivered family therapy treatment for perinatal depression and anxiety and (2) a video-delivered infant care provider training on addressing the parenting needs of depressed and anxious mothers. Objective: This paper describes the feasibility of implementing the FBCCM with families and infant care providers. Findings are presented on the preliminary effectiveness of the video-delivered family therapy treatment in reducing maternal depressive and anxiety symptoms, and family conflict. Methods: This pilot study was carried out using an implementation-effectiveness hybrid trial design without a comparison group. Changes in maternal depressive symptoms, maternal anxiety symptoms, and family conflict were measured at posttreatment, 3 months, and 6 months later. Results: On average, mothers (n=24) attended 9.79 (SD 1.02) sessions. On average, their family members (n=24) attended 9.42 (SD 1.28) sessions. A total of 31 infant care providers attended the training on addressing the parenting needs of depressed and anxious mothers. Mothers reported a significant reduction in depressive symptoms (P<.001) and anxiety symptoms (P<.001) from baseline to the 6-month follow-up. Mothers reported a significant reduction in conflict (P<.001), and their family members also reported a significant reduction in conflict (P=.007) from baseline to the 6-month follow-up. Conclusions: The findings from this study provide support for the feasibility and preliminary effectiveness of the FBCCM. The findings will be used to inform a larger study of the FBCCM. ",
doi="10.2196/45616",
url="https://pediatrics.jmir.org/2023/1/e45616",
url="http://www.ncbi.nlm.nih.gov/pubmed/37052997"
}


@Article{info:doi/10.2196/43837,
author="Haramati, Sharon
and Firsow, Anastasia
and Navarro, Abigail Daniela
and Shechter, Ravid",
title="Novel At-Home Mother's Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment",
journal="JMIR Pediatr Parent",
year="2023",
month="Aug",
day="22",
volume="6",
pages="e43837",
keywords="breastfeeding",
keywords="feasibility",
keywords="human milk",
keywords="biomarker",
keywords="remote sensing technology",
keywords="mobile health",
keywords="retrospective",
keywords="secretory activation",
keywords="lactogenesis",
keywords="milk supply",
keywords="milk",
keywords="sensing technology",
keywords="monitoring tool",
keywords="lactation",
keywords="exclusive breastfeeding",
keywords="breastfeed",
keywords="maternal health",
keywords="maternal and infant health",
keywords="infant health",
keywords="maternal and child health",
keywords="prolactin",
keywords="lactation consultant",
keywords="lactation support provider",
keywords="mother",
keywords="milk maturation",
abstract="Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM\%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth--dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system's results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM\%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM\% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth--dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. ",
doi="10.2196/43837",
url="https://pediatrics.jmir.org/2023/1/e43837",
url="http://www.ncbi.nlm.nih.gov/pubmed/37464893"
}


@Article{info:doi/10.2196/42265,
author="Lightner, Joseph
and Eighmy, Katlyn
and Valleroy, Ella
and Wray, Bridget
and Grimes, Amanda",
title="The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Jan",
day="25",
volume="6",
pages="e42265",
keywords="physical activity",
keywords="adolescent",
keywords="sport sampling",
keywords="physical literacy",
keywords="BMI",
keywords="health intervention",
keywords="parenting",
keywords="healthy lifestyle",
keywords="youth",
keywords="health inequality",
keywords="underserved population",
abstract="Background: Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. Objective: The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. Methods: Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. Results: The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). Conclusions: An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. International Registered Report Identifier (IRRID): RR2-10.2196/37126 ",
doi="10.2196/42265",
url="https://pediatrics.jmir.org/2023/1/e42265",
url="http://www.ncbi.nlm.nih.gov/pubmed/36696161"
}


@Article{info:doi/10.2196/44928,
author="Milton, Clare Alyssa
and Mengesha, Zelalem
and Ballesteros, Kristin
and McClean, Tom
and Hartog, Saskia
and Bray-Rudkin, Lucie
and Ngo, Cathy
and Hickie, Ian",
title="Supporting Children's Social Connection and Well-Being in School-Age Care: Mixed Methods Evaluation of the Connect, Promote, and Protect Program",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="25",
volume="6",
pages="e44928",
keywords="participatory design",
keywords="evaluation",
keywords="children",
keywords="school-age care",
keywords="after-school care",
keywords="health",
keywords="well-being",
keywords="program development",
keywords="community consultation",
abstract="Background: School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school--age children's social, emotional, physical, and cognitive well-being. Objective: This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. Methods: A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. Results: The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children's well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children's prosocial behaviors increased (mean difference=0.64; P=.04; t57=?2.06, 95\% CI ?1.36 to ?0.02) and peer problems decreased (mean difference=?0.69; P=.01; t57=2.57, 95\% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. Conclusions: To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them. ",
doi="10.2196/44928",
url="https://pediatrics.jmir.org/2023/1/e44928",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490323"
}


@Article{info:doi/10.2196/38921,
author="Crouse, J. Jacob
and LaMonica, M. Haley
and Song, Christine Yun Ju
and Boulton, A. Kelsie
and Rohleder, Cathrin
and DeMayo, M. Marilena
and Wilson, E. Chloe
and Loblay, Victoria
and Hindmarsh, Gabrielle
and Stratigos, Tina
and Krausz, Michael
and Foo, Nathanael
and Teo, Melissa
and Hunter, Andrew
and Guastella, J. Adam
and Banati, B. Richard
and Troy, Jakelin
and Hickie, B. Ian",
title="Designing an App for Parents and Caregivers to Promote Cognitive and Socioemotional Development and Well-being Among Children Aged 0 to 5 Years in Diverse Cultural Settings: Scientific Framework",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="13",
volume="6",
pages="e38921",
keywords="early childhood development",
keywords="digital technology",
keywords="health information technology",
keywords="mHealth",
keywords="smartphone",
keywords="neuroscience",
keywords="pediatrics",
keywords="mobile app",
doi="10.2196/38921",
url="https://pediatrics.jmir.org/2023/1/e38921",
url="http://www.ncbi.nlm.nih.gov/pubmed/36780220"
}


@Article{info:doi/10.2196/46555,
author="Weitzman, R. Elissa
and Minegishi, Machiko
and Cox, Rachele
and Wisk, E. Lauren",
title="Associations Between Patient-Reported Outcome Measures of Physical and Psychological Functioning and Willingness to Share Social Media Data for Research Among Adolescents With a Chronic Rheumatic Disease: Cross-Sectional Survey",
journal="JMIR Pediatr Parent",
year="2023",
month="Dec",
day="6",
volume="6",
pages="e46555",
keywords="patient-reported outcomes",
keywords="PROM",
keywords="outcome measure",
keywords="outcome measures",
keywords="patient reported",
keywords="patient data",
keywords="social media",
keywords="sharing",
keywords="personally generated data",
keywords="chronic illness",
keywords="quality of life",
keywords="rheumatic disease",
keywords="rheumatic",
keywords="rheumatoid",
keywords="adolescent",
keywords="adolescents",
keywords="youth",
keywords="research involvement",
keywords="privacy",
keywords="confidentiality",
keywords="confidential",
keywords="personal",
abstract="Background: Social media data may augment understanding of the disease and treatment experiences and quality of life of youth with chronic medical conditions. Little is known about the willingness to share social media data for health research among youth with chronic medical conditions and the differences in health status between sharing and nonsharing youth with chronic medical conditions. Objective: We aimed to evaluate the associations between patient-reported measures of disease symptoms and functioning and the willingness to share social media data. Methods: Between February 2018 and August 2019, during routine clinic visits, survey data about social media use and the willingness to share social media data (dependent variable) were collected from adolescents in a national rheumatic disease registry. Survey data were analyzed with patient-reported measures of disease symptoms and functioning and a clinical measure of disease activity, which were collected through a parent study. We used descriptive statistics and multivariate logistic regression to compare patient-reported outcomes between youth with chronic medical conditions who opted to share social media data and those who did not opt to share such data. Results: Among 112 youths, (age: mean 16.1, SD 1.6 y; female: n=72, 64.3\%), 83 (74.1\%) agreed to share social media data. Female participants were more likely to share (P=.04). In all, 49 (43.8\%) and 28 (25\%) participants viewed and posted about rheumatic disease, respectively. Compared to nonsharers, sharers reported lower mobility (T-score: mean 49.0, SD 9.4 vs mean 53.9, SD 8.9; P=.02) and more pain interference (T-score: mean 45.7, SD 8.8 vs mean 40.4, SD 8.0; P=.005), fatigue (T-score: mean 49.1, SD 11.0 vs mean 39.7, SD 9.7; P<.001), depression (T-score: mean 48.1, SD 8.9 vs mean 42.2, SD 8.4; P=.003), and anxiety (T-score: mean 45.2, SD 9.3 vs mean 38.5, SD 7.0; P<.001). In regression analyses adjusted for age, sex, study site, and Physician Global Assessment score, each 1-unit increase in symptoms was associated with greater odds of willingness to share social media data, for measures of pain interference (Adjusted Odds Ratio [AOR] 1.07, 95\% CI 1.001-1.14), fatigue (AOR 1.08, 95\% CI 1.03-1.13), depression (AOR 1.07, 95\% CI 1.01-1.13), and anxiety (AOR 1.10, 95\% CI 1.03-1.18). Conclusions: High percentages of youth with rheumatic diseases used and were willing to share their social media data for research. Sharers reported worse symptoms and functioning compared to those of nonsharers. Social media may offer a potent information source and engagement pathway for youth with rheumatic diseases, but differences between sharing and nonsharing youth merit consideration when designing studies and evaluating social media--derived findings. ",
doi="10.2196/46555",
url="https://pediatrics.jmir.org/2023/1/e46555"
}


@Article{info:doi/10.2196/44615,
author="Amore, Dunn Alexis
and Britt, Abby
and Arconada Alvarez, J. Santiago
and Greenleaf, N. Morgan",
title="A Web-Based Intervention to Address Risk Factors for Maternal Morbidity and Mortality (MAMA LOVE): Development and Evaluation Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Aug",
day="18",
volume="6",
pages="e44615",
keywords="maternal mortality prevention",
keywords="mobile technology",
keywords="pregnancy",
keywords="Black women",
keywords="maternal",
keywords="pregnant",
keywords="mortality",
keywords="web-based",
keywords="utility",
keywords="usability",
keywords="mHealth",
keywords="mobile health",
keywords="algorithm",
keywords="development",
keywords="design",
keywords="software",
keywords="risk assessment",
keywords="patient education",
abstract="Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation's worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool's initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals. ",
doi="10.2196/44615",
url="https://pediatrics.jmir.org/2023/1/e44615"
}


@Article{info:doi/10.2196/43602,
author="Parchomchuk, Evan
and Holt, Tanya
and Hansen, Gregory",
title="Canadian Pediatric Intensive Care Adaptations for Critically Ill Adults During the COVID-19 Pandemic: Survey Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="10",
volume="6",
pages="e43602",
keywords="Canada",
keywords="COVID-19 pandemic",
keywords="delivery of health care",
keywords="pediatrics",
keywords="population health",
keywords="health care",
keywords="intensive care",
keywords="patient care",
abstract="Background: The COVID-19 pandemic overwhelmed Canadian hospitals with adult admissions. A large number of adult patients required critical care therapies, placing significant strain on hospital resources. In order to decompress adult intensive care units, pediatric intensive care units (PICUs) introduced adapted models of traditional care to lessen these burdens. Objective: We aimed to evaluate how PICUs across Canada adapted care for the high volumes of critically ill adults. Methods: A survey containing 40 questions was sent to the medical directors of 14 Canadian PICUs where English was the primary clinical language. The survey was designed to gain perspective on the various adaptations that PICUs instituted during the COVID-19 pandemic. Results: Of the 13 PICUs that returned survey responses (response rate: 13/14, 93\%), 10 (77\%) participated in at least one adaptation to support the influx of admitted adults with COVID-19. The key challenges included disorganization, loss of autonomy, and compromised patient care. The significant advantages of these adaptations included a sense of learning and comradery. Conclusions: Our study highlighted an unpreparedness in critical care surge capacity. During the COVID-19 pandemic, adaptations rapidly emerged in Canada that involved PICUs with adult care. In the future, preplanned adaptations for optimizing robust critical care services should be developed based on what has been learned from the COVID-19 pandemic. ",
doi="10.2196/43602",
url="https://pediatrics.jmir.org/2023/1/e43602",
url="http://www.ncbi.nlm.nih.gov/pubmed/36724349"
}


@Article{info:doi/10.2196/48201,
author="Yam-Ubon, Umaporn
and Thongseiratch, Therdpong",
title="Using a Design Thinking Approach to Develop a Social Media--Based Parenting Program for Parents of Children With Attention-Deficit/Hyperactivity Disorder: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="28",
volume="6",
number="1",
pages="e48201",
keywords="attention-deficit/hyperactivity disorder",
keywords="ADHD",
keywords="parenting programs",
keywords="human-centered design thinking",
keywords="online interventions",
keywords="COVID-19 pandemic",
keywords="children",
keywords="development",
keywords="online parenting program",
keywords="parenting",
keywords="behavior",
keywords="support",
keywords="feasibility",
keywords="social media",
keywords="prototype",
keywords="testing",
keywords="design",
abstract="Background: Parenting programs have proven effective in improving the behavior of children with attention-deficit/hyperactivity disorder (ADHD). However, barriers such as job and transportation constraints hinder parents from attending face-to-face therapy appointments. The COVID-19 pandemic has further exacerbated these challenges. Objective: This study aimed to develop and test the feasibility of a social media--based parenting program for parents of children with ADHD, considering both the pre-existing challenges faced by parents and the additional barriers imposed by the COVID-19 pandemic. Methods: This study used a 5-stage design thinking process, encompassing empathizing with parents, defining their needs, ideating innovative solutions, prototyping the program, and testing the program with parents. Qualitative interviews were conducted with 18 parents of children with ADHD to understand their unique needs and values. Brainstorming techniques were used to generate creative ideas, leading to the creation of a prototype that was tested with 32 parents. Participants' engagement with the program was measured, and posttraining feedback was collected to assess the program's effectiveness. Results: Parents of children with ADHD encounter specific challenges, including managing impulsive behavior and difficulties in emotion regulation. The social media--based parenting program was delivered through the LINE app (Line Corporation) and consisted of 7 modules addressing topics related to ADHD management and effective parenting strategies. The program exhibited a high completion rate, with 84\% (27/32) of participants successfully finishing it. Program provider--participant interaction peaked during the first week and gradually decreased over time. Qualitative feedback indicated that the program was feasible, accessible, and well received by participants. The LINE app was found to be convenient and helpful, and participants preferred content delivery once or twice per week, expressing acceptance for various content formats. Conclusions: This study emphasizes the significance of adopting a human-centered design thinking approach to develop parenting programs that cater to the unique needs and values of parents. By leveraging social media platforms, such as LINE, a parenting program can overcome the challenges posed by the COVID-19 pandemic and other constraints faced by parents. LINE offers a viable and feasible option for supporting parents of children with ADHD, with the potential for customization and widespread dissemination beyond the pandemic context. ",
doi="10.2196/48201",
url="https://pediatrics.jmir.org/2023/1/e48201"
}